7 Ways to Protect Yourself from Medical Identity Theft

Peter Budetti, MD, JD, Deputy Administrator for Program Integrity

Fraud affects everyone. We’ve said it before – but this time we’re not just talking about people with Medicare. As my colleague Dr. Shantanu Agrawal and I pointed out in a recent article in the Journal of the American Medical Association, physicians are also vulnerable to a type of fraud called “medical identity theft.”

Medical identity theft happens when a fraudster uses your unique medical identifiers to bill insurance for items or services that you never provided or prescribed. Examples of these medical identifiers could be your National Provider Identifier (NPI), Tax ID Number (TIN), and medical licensure information. You pay for this kind of fraud with increased financial liabilities – you may be expected to pay taxes on earnings you never received, or repay insurance companies for payments on items or services that you never provided. You may also become the physician of record for services you had nothing to do with.

How to Protect Yourself

  1. Keep your medical information up-to-date. Report any changes to Medicare, Medicaid, and other insurance companies, such as opening and closing of offices and moving between group practices.
  2. Review billing notices. Actively review your Medicare remittance notices to make sure there are no items or services listed that you didn’t provide, including payments to you for services you didn’t provide.
  3. Protect your medical information. There are things you can do to better protect your information. For example, before giving out your medical identifiers to potential employers or other organizations, check them out to be sure they’re legitimate. Only give your information to trusted sources.
  4. Train your staff. Make sure your employees know the proper way to use and distribute your medical information, such as on prescription pads, electronic health records, and on other important documentation.
  5. Educate your patients. Patients are victims, too. Medical identity theft leads to higher insurance costs. Also, if patients are charged for items or services they never received, they may be denied in the future when they really need them. Tell patients to be on the lookout for fraudulent activity on their explanation of benefits statements, and how to report fraud when they see it.
  6. Report any suspected medical identity theft. If you believe you may have been the victim of identity theft, call the CMS program integrity investigative contractor in your region,which you can find at this location: http://www.cms.gov/MedicareProviderSupEnroll/downloads/ProviderVictimPOCs.pdf You may also report any suspected cases of medical identity theft to the Office of the Inspector General.
  7. Protect your prescription pads. Keep your prescription pads in a safe and secure environment, so they can’t be used by fraudsters to obtain prescriptions you never prescribed.

Medicare fraud and identity theft affects everyone. That’s why it’s very important for all of us to work together to stop it.

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