10 Warning Signs of Medical Fraud and How to Protect Yourself

Health insurance is meant to give you access to necessary treatments, preventive services, and emergency care. Unfortunately, it has also become a target for scammers looking for a quick payday.

In February, Change Healthcare suffered a cyber-attack affecting thousands of healthcare providers, insurers, and policyholders across the nation. Reports suggest that about 50% of all US medical claims could be compromised. To illustrate, if you’re in a waiting room with nine others, there’s a high likelihood that half of you could fall victim to medical identity theft within the year. The impact of this fraud is enormous, disrupting countless lives and access to medical care. Once your medical information is exposed, thieves can file false claims, purchase expensive prescriptions, and more—all charged to your account.

Some people are discovering their victimization in shocking ways. They might face tax or mortgage fraud, or they might find out they’ve exhausted their benefits for procedures they never had. Imagine going to the doctor expecting a routine check-up, only to receive a rejection letter from your insurance, claiming you’ve used up your benefits for multiple procedures—procedures you never had. This happens because someone has stolen your medical ID and used it for their own procedures.

Medical fraud can also involve manipulative organizations that exploit your medical information for fake billing schemes. They submit false claims for services you never requested or received, pocket the payments, and leave you with the bill. Recently, 193 defendants, including 76 healthcare professionals, were charged for their roles in various fraud schemes that resulted in $2.75 billion in false billings to federal programs. Medical fraud is a serious issue!

How to Spot Medical Identity Theft

Here are 10 signs that your medical ID might be compromised:

1. Unexpected Medical Bills: Receiving bills for medical services you didn’t get is a significant warning sign.
2. Collection Notices: Being contacted by debt collectors for medical bills that aren’t yours.
3. Errors in Medical Records: Finding inaccuracies in your medical records, such as treatments you didn’t receive or incorrect diagnoses.
4. Insurance Issues: Claims being denied because your benefits are maxed out or you’ve hit your coverage limit, despite not using any services.
5. Insurance Provider Alerts: Receiving notifications from your insurer about claims or services you don’t recognize.
6. Unknown Accounts: Discovering new health insurance accounts or medical records in your name that you didn’t create.
7. Discrepancies in Explanation of Benefits (EOB): Your EOB statements list services you didn’t receive.
8. Insurance Denial: Difficulty obtaining life or health insurance because your records show medical conditions you don’t have.
9. Calls from Medical Providers: Receiving calls about appointments or follow-ups for treatments you never had.
10. Unfamiliar Prescriptions: Notices about prescriptions filled in your name that you did not authorize.

How to Protect Yourself from Medical ID Fraud

Avoid becoming a victim of medical identity theft with these preventive steps:

• Check for Breaches: Use a searchable database to see if your healthcare information has been compromised.
• Secure Your Records: Store physical copies of medical records in a safe place. If your healthcare provider’s system is compromised, you’ll be glad you did.
• Shred Documents: Shred any documents with personal information before disposal.
• Monitor Your Records: Regularly review your medical records from your healthcare providers for any unfamiliar treatments or inaccuracies.
• Review Insurance Bills: Scrutinize your EOB statements for any services you didn’t receive and report unfamiliar charges to your insurer immediately. Follow up with the credit bureaus if necessary at IdentityTheft.gov.
• Dispose of Prescription Labels: Remove labels from empty prescription bottles before discarding them to prevent identity theft.
• Monitor Your Credit: Obtain your free credit reports from AnnualCreditReport.com three times a year to watch for suspicious activity.

Healthcare will always be a target for hackers, and attacks on medical facilities will continue. It’s crucial to take proactive measures to safeguard yourself. We can help identify your risk with a FREE Dark Web Scan. This scan quickly reveals if your information is on the dark web or if you’ve been affected by a data breach. To schedule your Dark Web Scan, call us at 717-914-0102 or click here.