9 Most Common Signs of Medical Identity Theft

The cost of healthcare scams in the U.S. is around $100-170 billion each year. It is usually the government and private health insurers that bear much of the financial burden. But as a healthcare receiver, you have a lot to lose as well when your medical identity gets compromised.

Think about it for a moment: When someone gets treatment under your name, those records are automatically added to your medical files. As a result, your doctors could later prescribe unnecessary drugs, jeopardizing your health and putting your life at risk.

And when your health insurance policy is used up to pay for someone else’s treatments, the insurer could deny coverage, forcing you to pay for your own medical expenses.

The bottom line is, medical identity theft is a serious issue that could result in various negative consequences if left unaddressed.

The first step to avoiding them is to build awareness: You can follow news sites to keep up with the latest identity theft trends and read articles about how to protect yourself online. What’s important is that you become familiar with the various threats to your medical data and make a conscious effort to minimize the risks.

In this article, we discuss what medical identity theft is all about and the telltale signs that could give it away.

Medical Identity Theft Explained

Your medical identity consists of various information that helps identify you as a healthcare receiver. This can include your full name, SSN, date of birth, patient number, health insurance ID, and medical data.

Medical identity-related details can appear in a number of places, including your health records (kept by the medical service provider), prescriptions, prescription bottles, medical insurance card, and the insurer’s explanation of benefits statement.

If a bad actor gets hold of any of these, they can use your medical identity to receive treatments, get prescription drugs, submit medical insurance claims, or make money by selling your data to others.

But how can someone access your medical ID details? They can use phishing techniques to trick you into revealing them (say, by impersonating your insurance company), scrape your social media account for critical information you may have posted there (remember the COVID vaccine card selfies?), or hack into your insurer’s customer database.

Internal theft, where staff at your healthcare provider gain unauthorized access to patient records, is common, too, while those prescription bottles and medical bills you frivolously throw away could also compromise your identity.

Telltale Signs of a Medical Identity Breach

Certain red flags could warn you about a possible breach of your medical identity. By spotting them on time, you have a higher chance of curbing the damage.

Here are the common signs to stay alert to:

1. Unexpected Bills and/or Supplies

Medical bills for treatments you never received and medical supplies you didn’t order could indicate that someone else is using your identity.

2. Inaccurate Details in Medical Records

These can relate to anything you don’t recall, like doctor’s visits, health issues, or services listed in your medical file.

3. Unusual Entries in the Insurer’s EOB Statement

Inaccurate details about doctors, visit dates, or treatments can appear on your explanation of benefits statements when unknown parties submit insurance claims.

4. Calls and Notices From Debt Collectors

Communications from debt collectors about unpaid medical bills for treatments you don’t recognize could mean that someone else has received such services under your name.

5. Unfamiliar Credit Report Entries

Credit reports typically list details relating to debt and collection notices. If you are certain you have settled all dues, it’s important to dig into such entries.

6. Denial of Coverage by the Insurer

When a fraudster uses up your health insurance benefits, the insurer will eventually refuse your medical claims, forcing you to cover expenses on your own. 

7. Higher Medical Insurance Premiums

The health insurance company could raise your premium the next time you renew the policy if critical health conditions get added to your medical history as a result of a scammer impersonating you.

8. Change-of-Personal-Data Confirmations

Have you received any notifications from your insurer or medical service provider confirming an address or some other detail change? This is a common red flag that your identity is compromised.

9. Data Breaches at Your Medical Service Provider

If your healthcare provider reports a data leak (due to a hacking attack, internal theft, etc.), it is likely someone else has gained access to your medical records. The same can happen with a breach at the health insurer.

How Can You Prevent or Mitigate Medical Identity Theft?

In most instances, medical identity breaches are preventable, provided you take adequate safety precautions.

Here’s what you need to do.

• Keep records of your healthcare visits, dates, and treatments so you can cross-check them against your EOB and medical reports.
• Review in detail important documents received from service providers (e.g., the explanation of benefits statements, bills, letters, notifications, bank statements, etc.).
• Be strict about how you share personal data with others. Ensure they have a valid reason to request medical information. Also, verify their identities to avoid phishing attempts.
• Store and discard health-related documents and materials in a safe manner.
• Use unique passwords and 2FA to protect your personal accounts from data breaches.
• Strengthen device security with passwords, anti-virus software, and VPNs to prevent unwelcome intrusions.
• Check your credit report regularly and address discrepancies without delay.

To Conclude About Medical ID Theft

A compromised medical identity can lead to various complications, not just for healthcare providers and insurers, but also for the patients.

When someone uses your medical insurance benefits posing as you, the insurer could deny coverage and raise your premium. It could also lead to inaccurate entries in your medical reports, causing doctors to prescribe treatments and drugs that may put your health at risk.

In some cases, you could face criminal charges, too (say, when an insurer alerts law enforcement about suspicious medical claims). You also can’t ignore the negative impact of unpaid bills on your credit report.

But you can avoid all these potential risks by learning how to spot a medical identity breach. With prompt action, much of the damage can be minimized, ensuring the safety of your medical ID.