Consequences to Beneficiaries

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Approximately 250,000 Medicare beneficiaries are listed as having had their medical identity compromised through stolen or misused Medicare numbers. Medicare numbers cannot be changed, so once a number has been compromised, that beneficiary’s future benefits and health care may be forever at risk.

Medical Identity Theft

Medical identity theft occurs when a beneficiary’s Medicare number is misused, either by a provider, a supplier, or by someone posing as the real beneficiary in order to receive medical care. Such Medicare numbers are considered “compromised.” Medicare numbers are for life, even if stolen or misused, so a beneficiary whose number is compromised may be affected forever by false claims against his or her Medicare number.

Health Impact

Receiving health care from a fraudulent provider can mean the quality of the care is poor, the intervention is not medically necessary, or worse: The intervention is actually harmful. A beneficiary may later receive improper medical treatment from legitimate providers as a result of inaccurate medical records that contain:

  • False diagnoses
  • Records showing treatments that never occurred
  • Misinformation about allergies
  • Incorrect lab results

Additionally, because of inaccurate or fraudulent claims to Medicare, beneficiaries may be denied needed Medicare benefits. For example, some services have limits. If Medicare thinks such services were already provided, they will deny payment.

Personal Financial Losses

Medicare fraud, errors, and abuse can all result in higher out-of-pocket costs for beneficiaries, such as copayments for health care services that were never provided, were excessive, or were medically unnecessary. Beneficiaries may also find themselves stuck with bills for services from providers who should have billed Medicare but instead billed the beneficiary for the entire cost of that service. Finally, because Medicare numbers also contain Social Security numbers, financial fraud can be a side effect of having one’s Medicare number compromised. Medicare numbers are as valuable as Social Security numbers to thieves who wish to set up credit card accounts with someone else’s identity.