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Identity Theft Help

Medical Identity Theft

Medical identity theft occurs when someone uses your name, insurance information, or Social Security number to obtain medical care, prescription drugs, or medical equipment. Unlike credit fraud, which you can dispute off your credit report, a fraudulent medical record can be nearly impossible to fully correct.

Why this is dangerous

  • •Wrong medical information in your file. The thief's blood type, allergies, medications, and diagnoses can be merged into your record — potentially life-threatening if you're treated based on that information.
  • •Exhausted insurance benefits. Your plan's annual or lifetime maximums can be depleted, leaving you uncovered.
  • •Collection accounts. Bills for care the thief received end up on your credit report.
  • •Employment and insurance consequences. A fraudulent diagnosis (HIV, hepatitis, substance abuse, mental illness) can affect employment background checks and life-insurance underwriting.

Signs of medical identity theft

  • •Explanation of Benefits (EOB) forms for care you didn't receive.
  • •Medical bills for services or prescriptions you don't recognize.
  • •Collection calls from medical providers you've never seen.
  • •Notice from your insurer that you've hit a benefit limit — when you haven't.
  • •Denials of coverage because your records show a pre-existing condition you don't have.

Immediate steps

  1. 1.Request your medical records from every provider involved. Under HIPAA, you have the right to obtain a copy of your records and to receive an "accounting of disclosures."
  2. 2.Request an amendment. HIPAA gives you the right to ask a provider to correct or annotate your record. The provider must respond within 60 days.
  3. 3.Notify your health insurer in writing that fraudulent claims have been filed under your policy.
  4. 4.File an FTC Identity Theft Report at IdentityTheft.gov.
  5. 5.File a police report.
  6. 6.Dispute medical-debt collections on your credit report with the credit bureaus, citing the identity theft.

Medicare and Medicaid fraud

If you're a Medicare beneficiary and suspect fraud, call 1-800-MEDICARE (1-800-633-4227) or contact the HHS Office of Inspector General at oig.hhs.gov/fraud. For Medicaid, contact your state's Medicaid Fraud Control Unit.

The records may never fully disappear

Unlike credit reports, where errors can be deleted, medical records often can only be annotated. The provider may add a note saying "patient disputes this entry," but the original information may remain visible. Document everything you do to correct the record — that documentation may be important later if you need to explain the discrepancy to an insurer or employer.