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Medical identity theft happens when someone uses your personal or insurance information to get care, obtain prescriptions or medical devices, or submit health-insurance claims. It can lead not only to bills and lost benefits, but also to inaccurate diagnoses, medicines, tests, or procedures in your medical record. If you spot a claim or record entry you do not recognize, verify it with the provider and insurer, then report and dispute it.
What is medical identity theft?
The Federal Trade Commission (FTC) defines medical identity theft as the use of identifying information—such as your name, Social Security number, health-insurance account number, or Medicare number—to obtain medical care, see a doctor, get prescription drugs or medical devices, or submit insurance claims. The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) also describes unauthorized use of personal information to submit claims to Medicare or other health insurers. FTC: What To Know About Medical Identity Theft; HHS OIG: Medical Identity Theft.
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It affects more than finances. A provider may mistakenly add another person’s diagnoses, test results, medications, or procedures to your file. Those entries can matter if a clinician later relies on the record to make care decisions. Unauthorized claims can also generate bills or collection activity, or use up insurance benefits. North Carolina’s Department of Justice describes these potential medical-record and financial consequences in its consumer guidance: Medical Identity Theft.
How can I tell if someone is using my health insurance?
An unfamiliar item is a warning sign, not proof of theft: billing mistakes can happen. Check with the provider and your insurer to confirm whether the service occurred and who received it. Pay particular attention to:
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- A bill or Explanation of Benefits (EOB) for a visit, procedure, test, or prescription you did not receive.
- A debt collector contacting you about unfamiliar medical care or a medical collection appearing on your credit report.
- A notice that your insurance benefits have reached a limit you did not expect.
- Diagnoses, medicines, test results, or procedures in your medical records that do not belong to you.
Compare the service date, provider, and description on an EOB or bill with your own appointments and prescriptions. If something still does not match, contact the provider and the health plan using contact details you already trust, such as the number on your insurance card.
How can I protect my medical information?
Secure paper records and insurance documents
Keep insurance cards, enrollment forms, prescriptions, prescription bottles, medical records, bills, and EOB notices somewhere secure. Retrieve mail promptly. Shred paperwork containing medical or insurance information before throwing it away; for prescription containers that are difficult to shred, the FTC advises obscuring identifying information. A cross-cut shredder can help destroy paper documents, but it does not protect digital records or prevent fraudulent calls.
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Question requests for sensitive information
Ask a medical office why it needs your Social Security number and whether it can use another identifier or only the last four digits. For requests for an insurance or Medicare number or health details, ask why the information is needed, how it will be protected, and whether it will be shared. Do not give medical details to an unexpected caller, email, or text. Instead, contact the provider or insurer through a website you know is official or a number independently verified from your card or prior paperwork.
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For Marketplace matters, HealthCare.gov advises using official government websites and not sharing personal, financial, or health information with unverified contacts: Protect yourself from fraud and scams.
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Understand the limits of HIPAA
HIPAA is not a universal privacy guarantee for every app or service that handles health-related information. HealthIT.gov says the HIPAA Privacy and Security Rules protect information held by covered healthcare providers and health insurers, but do not apply when a person shares information with an organization that is not covered by HIPAA. Check an app or service’s privacy terms and determine whether it is covered rather than assuming coverage because it deals with health. HealthIT.gov: Health Information Privacy and Security Basics.
What should I do about a medical bill I don’t recognize?
- Contact the insurer’s fraud department. Review the EOB and report claims that do not match care you received. For Medicare, use Medicare’s official reporting route; HHS OIG advises first asking the provider about questionable charges.
- Request and review your records. Contact the relevant providers, hospitals, clinics, pharmacies, laboratories, and health plans. Ask for copies and look for services, procedures, diagnoses, medicines, or test results that are not yours.
- Dispute inaccurate record entries in writing. Identify each error, include the relevant record and an explanation, and ask the provider to correct the information and notify other providers that may hold the same error. The FTC says the provider must respond to a correction request within 30 days. Keep a copy and proof of delivery.
- Report the identity theft. Use IdentityTheft.gov to report what happened and get a personalized recovery plan. Send the FTC report to your insurer’s fraud department.
- Check for billing and credit effects. Review your credit reports and follow the FTC’s identity-theft recovery instructions for medical billing errors. The FTC points consumers to AnnualCreditReport.com, the federally authorized source for free credit reports.
If Medicare is involved
For questionable Medicare charges, HHS OIG recommends contacting the provider first. If the issue is unresolved, contact 1-800-MEDICARE or your local Senior Medicare Patrol. Suspected Medicare fraud can also be reported through the HHS OIG fraud reporting page. Use the official HHS OIG guidance for current reporting details: Medical Identity Theft.
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Are identity-monitoring services necessary?
Commercial identity-monitoring, recovery-assistance, and identity-theft-insurance services are optional. The FTC notes that most identity-monitoring services do not alert users when someone misuses Medicare or Medicaid benefits. A paid service therefore should not be treated as a comprehensive way to detect or prevent medical identity theft. Start with the free official reporting and recovery steps above. FTC: Identity Theft Services.
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