ITRC Fact Sheet 130
Basic Medical Identity Theft
In this guide, you will find the beginning steps to take as a victim of medical identity theft. This is a general guide for remediating medical identity theft. Should your case be complex or if you are having trouble resolving your case, please call our office at our toll-free number, 888-400-5530, for further assistance.
- Medical Identity Theft: Someone is fraudulently using your personally identifiable information (PII), such as your name, Social Security number, and medical insurance identity number to obtain medical goods or services, or to fraudulently bill for medical goods or services under your name.
- Government Medical Benefit Identity Theft: Someone is fraudulently using your (PII) to obtain government medical benefits under your name.
Medical Identity Theft:
An example of this type of fraud would be a criminal using your PII to receive surgery under your name. You may detect this medical identity theft by:
- Carefully reading any Explanation of Benefit letters you receive to make sure that all medical services listed in the letter were actually provided to you.
- Reviewing your credit reports to see if any delinquent medical bills have been reported to the credit reporting agencies.
- Receiving a collection letter from a collection agency claiming that you have unpaid medical bills.
What to do when you find that you have become a victim of Medical Identity Theft:
- Request copies of your medical records from any health care provider where you feel your identity was fraudulently used. If you are denied copies of your medical records, you have a right to appeal their decision. You are entitled to knowing what is in your medical records. If the provider still denies you access to your medical records after 30 days of your written request, you have the right to file a complaint with the Office for Civil Rights in the U.S. Department of Health and Human Services. See ITRC Fact Sheet FS 130A for information on how to correct misinformation in your medical records.
- Request an accounting of disclosures from your health care provider. This is a list of entities that your health care provider gave your protected health information to and may contain the same errors that exist in the original health care provider’s medical records in your name. The original health care provider must notify the other providers of the mistakes in the records they sent, but you may want to check with them yourself.
- Contact the billing department of the medical facility or doctor requesting payment. If you are receiving this notice from a collection agency, then contact the collection agency first. Explain that this is a case of identity theft or mistaken identity. If the billing department is reluctant to help, then contact the attending doctor, or the medical facility’s fraud or legal department.
- Ask what proof they have that this person is you. There is almost always a physical description of the patient. Does it match you? You might be able to show that your height, weight, skin color, age, blood type, or sex is not the same as the “patient.”
- Ask when the medical service was provided. You might be able to prove you were somewhere else during that period.
- What service was provided? If surgery was done or a condition was diagnosed, you might be able to prove you don’t have a scar or that condition.
- Ask if your Social Security Number (SSN) was used or just a name and address. If your SSN was used, you will need to follow the information in ITRC Fact Sheet FS 100 – Financial Identity Theft: the Beginning Steps and check your credit reports. This thief may be affecting your credit status in other ways. They may be opening new lines of credit or leaving other collection actions behind.
- Ask if this person used your medical insurance card or number. If so, contact your insurance company and report the problem. Ask for a new number on the replacement card. They may also have a fraud department that tracks cases.
- File a police report in your city and state of residence. You are a victim of a crime. At your earliest opportunity, obtain a copy of the police report.
- Send copies of your affidavit of fraud, the police report, any other supporting documentation proving identity theft to the medical billing department and any additional collection agencies which may be involved. Please remember to mail this documentation certified, return receipt requested.
- Once the provider agrees this is a case of fraud or identity theft, get that agreement in writing and keep it in a safe place with other important records.
- If someone is receiving government medical benefits under your name ask to have your benefits temporarily reinstated while the investigation is going on so that you can continue to receive medical help, if necessary.
For more details on various financial identity theft issues, please see our ITRC Fact Sheet FS 100A - More Complex Cases.
Report Medicare Fraud:
Department Of Health & Human Services: Office Of Inspector General Hotline
- Phone: 1-800-447-8477
TTY #: 1-800-377-4950
You can also contact your local Senior Medicare Patrol. They work locally to empower seniors to fight health care fraud and resolve errors.
- Phone: 1-877-808-2468
ITRC Fact Sheet FS 130A - Correcting Misinformation on Medical Records