Medical Identity Theft

1. Consumer Affairs Branch
Fairfax County Department of
Cable and Consumer Services
fairfaxcounty.gov/consumer
Medical Identity Theft

2.  Medical identity theft happens when
someone steals your personal
information and uses it to commit
health care fraud.

3.  An individual has no health insurance, but needs
treatment, surgery or prescription drugs and uses
your medical information to obtain those services
 People working in a medical setting submit false bills
to collect money
 An individual may steal someone’s identity to hide
pre-existing medical conditions from employers or
insurance providers

4.  A record is created in your name with the imposter’s
medical information
◦ Individual and family medical history
◦ Blood type
◦ History of smoking and drug or alcohol use
◦ Lab test results
◦ Diagnosis of illness, allergy, diseases or other
conditions
◦ Prescriptions

5.  You receive a bill for medical services you didn’t
receive
 A debt collector contacts you about medical debt that
you don’t owe
 You see unrecognizable medical collection notices on
your credit report

6.  Your health insurance denies a legitimate
medical claim because you’ve reached your
limit on benefits
 You are denied insurance because your
medical records show a condition you don’t
have

7.  Verify a source before sharing information
◦ Don’t give out personal information on the phone
or through the mail unless you’ve initiated the
contact
◦ Be wary of offers of “free” health services or
products from providers who require you to give
them your health plan ID number.

8.  Safeguard your medical and health insurance
information
◦ Keep copies of your medical or health insurance
records secure
◦ If asked to share your social security number or,
insurance account information or other details – ask
WHY?
◦ Be on guard when using the internet. Read website
privacy policies and make sure the site is secure

9.  Treat your trash carefully
◦ Shred health insurance forms and prescription and
physician statements
◦ Destroy labels on your prescription bottles and
packages before throwing them out

10.  Read the Explanation of Benefits (EOB)
statement
◦ Medicare beneficiaries – read Medicare Summary
Notice
◦ Make sure claims match the care you received
◦ Verify the name of the provider, the date of service
and the service provided
◦ If there is a discrepancy – contact your health plan
to report the problem

11.  Keep track of communications with health
plan and providers
◦ Postal and email correspondence
◦ Phone calls, conversation and activities
 Order a copy of your credit reports
◦ Review carefully
◦ Law requires each reporting agency to provide a
free report annually if you ask for it

12. Annual Credit Report Request Service
P.O. Box 105281
Atlanta, GA 30348-5281
www.AnnualCreditReport.com
1-877-322-8228
www.ftc.gov/freereports

13.  Ask for a copy of your medical records
◦ The Health Insurance Portability and Accountability Act
(HIPAA) Privacy Act Rule
◦ Right to copies of your records that are maintained
by health plans and medical providers covered by
the law
◦ Required to give you your files within 30 days after
you ask for them
◦ Make a request to each provider

14.  Make a request to each provider
◦ Doctors
◦ Clinics
◦ Hospitals
◦ Pharmacies
◦ Laboratories
◦ Health Plans
 A written request and a fee for the records
may be required

15.  If you are denied access to your records – you
must be provided a reason in writing
◦ You have the right to appeal if your request is
denied
◦ Contact the Person identified in the Notice of
Privacy Practices
◦ US Department of Health and Human Services’
Office for Civil Rights – www.hhs.gov.ocr

16.  Obtain a copy of the accounting disclosures
for your medical record
◦ Date of the disclosure
◦ Name of the person or entity who received the
information
◦ Brief description of the information disclosed
◦ Brief statement of the purpose of the disclosure
 The law allows one free copy of the
accounting from each of your providers every
12 months

17.  U.S. Department of Health and Human
Services, Office of Civil Rights at
www.hhs.gov/ocr
 World Privacy Forum at
www.worldprivacyforum.org/FAQ_medical
recordprivacy.html

18.  File a complaint with the Federal Trade
Commission
◦ https://www.ftccomplaintassistant.gov
◦ 1-877-ID-THEFT (438-4338)
◦ TTY 1-866-653-4261

19.  File a report with your local police
◦ Send copies of the report to
 your health plan’s fraud department
 Your health care provider(s)
 The three nationwide credit reporting companies
 More information about how to file a police
report is at
www.ftc.gov/idtheft/consumers/defend.html

20.  Exercise your right under HIPAA to correct
errors in your medical and billing records
◦ Write to your health plan or provider detailing the
information that seems inaccurate
◦ Include copies (keep originals) of any document
that supports your position
◦ Identify each item in your record that you dispute
◦ State the facts and reasons for disputing the
information
◦ Request that each item be corrected or deleted

21.  Exercise your right under HIPAA to correct
errors in your medical and billing records
◦ Request that each item be corrected or deleted
◦ You may want to include a copy of your medical
record with the items in question circled
◦ Send your letter by certified mail and ask for a
“return receipt”
◦ Keep copies of the dispute letter and enclosures

22.  Generally the health plan or medical provider
must respond
◦ The creator of the information is obligated to
amend the inaccurate or incomplete information
◦ It should notify other parties, like labs or other
health care providers, that they may have received
incorrect information
◦ If the investigation does not resolve your dispute –
request that a statement of the dispute be included
in your record

23.  Fraud Alert – can help prevent an identity
thief from opening additional accounts in
your name
 Contact each of the three nationwide credit
reporting companies
◦ TransUnion
◦ Equifax
◦ Experian

24.  Security Freeze – also known as a credit
freeze, is a warning to businesses or others
who may use your credit file. It locks down
your credit file and blocks access by potential
creditors
◦ Does not affect your credit score
◦ Does not keep you from obtaining your free annual
credit report
◦ Does not keep your from buying your credit report
or score
 It can be temporarily lifted or removed by
request

25. Center on Medical Record Rights and
Privacy
Health Policy Institute
Georgetown University
Box 57144
Washington, DC 20057-1485
202-687-0880
http://ihcrp.georgetown.edu/privacy/records.html

26. World Privacy Forum
2033 San Elijo Avenue, #402
Cardiff by the Sea, CA 92007
760-436-2489
www.worldprivacyforum.org

27. U.S. Department of Health and Human
Services
Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
www.hhs.gov/ocr
www.fairfaxcounty.gov/consumer

28. Medical Information Bureau (MIB)
Has records of individuals that have applied for
individual insurance in the last seven years with
an MIB Member
Get a copy of your MIB consumer file annually
without charge
Phone 866-692-6901
TTY 866-346-3642
www.fairfaxcounty.gov/consumer

29. Fairfax County Financial Crimes Division of the
Fairfax County Police Department
703-246-7800
http://www.fairfaxcounty.gov/police
www.fairfaxcounty.gov/consumer

30. Virginia Department of Health Professions
Enforcement Division
6603 West Broad Street, 5th Floor
Richmond, VA 23230-1712
800-533-1560
804-662-7079
www.dhp.virginia.gov
www.fairfaxcounty.gov/consumer

31. Questions

32. Fairfax County Consumer Affairs Branch
12000 Government Center Parkway, Suite 433
Fairfax, VA 22035
703-222-8435
www.fairfaxcounty.gov/consumer