The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

From the Office of Inspector General (OIG), U.S. Department of Health & Human Services

Medical Identity Theft

Medical identity theft occurs when someone steals your personal information (like your name, Social Security number or Medicare number) to obtain medical care, buy drugs or submit fraudulent billings to Medicare in your name. It is the nation’s fastest-growing form of identity theft and is contributing to the rising cost of health care and, in some instances, diminishing the quality of care provided.

How the Scam Works

  • Medical identity thieves will steal your information, then create large lists of patients and sell them multiple times to fraudulent companies. In addition to the street-scam methods of stealing your information, we are also seeing individuals who have been planted as employees inside health care clinics, offices and hospitals to steal patient information out of the computers. And it’s not just patients getting their data stolen: Physicians are getting their data stolen in record numbers as well.
  • Unfortunately, there are always new and inventive ways medical identity thieves will try to steal your Medicare number and personal information. They may meet you outside the supermarket and offer you free vitamins or groceries courtesy of Medicare. But before you receive the vitamins, they must verify you are with Medicare by making a copy of your Medicare card. Alternatively, street scammers may set up as temporary vendors in shopping plazas and the like. They will offer free screening such as blood pressure, cholesterol and glucose checks. They will ask you to fill out a survey and provide protected information such as name, address, Social Security number and Medicare number. They have just stolen your information.
  • In another scenario, you may receive a phone call from someone pretending to be from a government agency wanting to verify your eligibility. She will try to talk you into giving her the numbers she needs right over the phone.
  • Another method of obtaining your personal information is under the pretext of computer repair. An unscrupulous computer repair shop can copy your hard drive while repairing your computer. Only use very reputable computer shops.

How to Fight Back

  • Safeguard your information and take steps to reduce your risk. Never provide any protected information over the phone unless you are absolutely sure of who is on the other end.
  • Monitor your personal financial accounts and billing statements. If you receive an Explanation of Benefits form from Medicare for a service you never received, or it supposedly occurred in an out-of-town or out-of-state clinic you’ve never heard of, then you may have been a victim of medical identity theft.
  • Act quickly when you suspect identity theft. To help protect yourself and Medicare, you should report all suspected instances of health care fraud and medical identity theft.

Report Suspected Fraud

To report suspected fraud, click here.

 

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