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Diagnosis: Fraud

September 01, 2016

Life is full of surprises. Imagine that you’re going through today’s mail or email, and you find an explanation of benefits from your health insurance company saying that your prostate surgery is 100% covered by your insurance. This should be good news, right? Except that you’re a 35-year-old woman. Or guys, imagine finding out that obstetrician visits have been billed to your insurance. Either way, it’s a disturbing surprise.

While these situations sound a bit funny, they’re deadly serious. What’s happening here is medical identity theft - when someone uses another person’s identity and health insurance to get healthcare coverage or, in the case of billing fraud, to get paid for healthcare coverage that was never really provided.

Medical identity theft really can be deadly. By introducing false information into your medical file, you could receive the wrong treatment in a medical emergency. Obviously, a doctor isn’t going to mistakenly order prostrate surgery for a female patient or recommend a hysterectomy for a man. But what if you showed up at the emergency room with appendicitis and the ER staff didn’t check for that because, due to identity theft, your record showed you already had your appendix removed. You could die! Medical identity theft can also use up your medical benefits and leave you facing bills for medical treatment you didn’t receive or, worse, denied medical coverage altogether.

There’s only so much you can do to protect yourself from medical identity theft. Criminals love to steal medical identities because they can be sold for a lot of money on the black market. So it’s no surprise that, according to the Ponemon Institute almost 90% of healthcare organizations had data breaches in the past two years.

Healthcare privacy laws are complicated, so recovery from medical identity theft can have more twists and turns than a season of Grey’s Anatomy. But checking the benefits statements from your medical insurance is a good way to spot problems early and limit the damage. And if you do discover fraudulent activity, you’re in good hands. MyIDCare Recovery Advocates know how to work with medical providers and healthcare insurance companies to repair your medical records, fight false insurance claims and make sure you won’t be liable to pay for medical bills that aren’t yours. Your personal medical drama won’t be the weekly buzz on Twitter, but you can rest assured of a happy ending.

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