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Consumer Affairs Branch
Fairfax County Department of
Cable and Consumer Services
fairfaxcounty.gov/consumer
Medical Identi...
 Medical identity theft happens when
someone steals your personal
information and uses it to commit
health care fraud.
 An individual has no health insurance, but needs
treatment, surgery or prescription drugs and uses
your medical informat...
 A record is created in your name with the imposter’s
medical information
◦ Individual and family medical history
◦ Blood...
 You receive a bill for medical services you didn’t
receive
 A debt collector contacts you about medical debt that
you d...
 Your health insurance denies a legitimate
medical claim because you’ve reached your
limit on benefits
 You are denied i...
 Verify a source before sharing information
◦ Don’t give out personal information on the phone
or through the mail unless...
 Safeguard your medical and health insurance
information
◦ Keep copies of your medical or health insurance
records secure...
 Treat your trash carefully
◦ Shred health insurance forms and prescription and
physician statements
◦ Destroy labels on ...
 Read the Explanation of Benefits (EOB)
statement
◦ Medicare beneficiaries – read Medicare Summary
Notice
◦ Make sure cla...
 Keep track of communications with health
plan and providers
◦ Postal and email correspondence
◦ Phone calls, conversatio...
Annual Credit Report Request Service
P.O. Box 105281
Atlanta, GA 30348-5281
www.AnnualCreditReport.com
1-877-322-8228
www....
 Ask for a copy of your medical records
◦ The Health Insurance Portability and Accountability Act
(HIPAA) Privacy Act Rul...
 Make a request to each provider
◦ Doctors
◦ Clinics
◦ Hospitals
◦ Pharmacies
◦ Laboratories
◦ Health Plans
 A written r...
 If you are denied access to your records – you
must be provided a reason in writing
◦ You have the right to appeal if yo...
 Obtain a copy of the accounting disclosures
for your medical record
◦ Date of the disclosure
◦ Name of the person or ent...
 U.S. Department of Health and Human
Services, Office of Civil Rights at
www.hhs.gov/ocr
 World Privacy Forum at
www.wor...
 File a complaint with the Federal Trade
Commission
◦ https://www.ftccomplaintassistant.gov
◦ 1-877-ID-THEFT (438-4338)
◦...
 File a report with your local police
◦ Send copies of the report to
 your health plan’s fraud department
 Your health ...
 Exercise your right under HIPAA to correct
errors in your medical and billing records
◦ Write to your health plan or pro...
 Exercise your right under HIPAA to correct
errors in your medical and billing records
◦ Request that each item be correc...
 Generally the health plan or medical provider
must respond
◦ The creator of the information is obligated to
amend the in...
 Fraud Alert – can help prevent an identity
thief from opening additional accounts in
your name
 Contact each of the thr...
 Security Freeze – also known as a credit
freeze, is a warning to businesses or others
who may use your credit file. It l...
Center on Medical Record Rights and
Privacy
Health Policy Institute
Georgetown University
Box 57144
Washington, DC 20057-1...
World Privacy Forum
2033 San Elijo Avenue, #402
Cardiff by the Sea, CA 92007
760-436-2489
www.worldprivacyforum.org
U.S. Department of Health and Human
Services
Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
www.h...
Medical Information Bureau (MIB)
Has records of individuals that have applied for
individual insurance in the last seven y...
Fairfax County Financial Crimes Division of the
Fairfax County Police Department
703-246-7800
http://www.fairfaxcounty.gov...
Virginia Department of Health Professions
Enforcement Division
6603 West Broad Street, 5th Floor
Richmond, VA 23230-1712
8...
Questions
Fairfax County Consumer Affairs Branch
12000 Government Center Parkway, Suite 433
Fairfax, VA 22035
703-222-8435
www.fairf...
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Medical Identity Theft

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Medical Identity Theft

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Medical Identity Theft

  1. 1. Consumer Affairs Branch Fairfax County Department of Cable and Consumer Services fairfaxcounty.gov/consumer Medical Identity Theft
  2. 2.  Medical identity theft happens when someone steals your personal information and uses it to commit health care fraud.
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 26. World Privacy Forum 2033 San Elijo Avenue, #402 Cardiff by the Sea, CA 92007 760-436-2489 www.worldprivacyforum.org
  27. 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. 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. 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. 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. 31. Questions
  32. 32. Fairfax County Consumer Affairs Branch 12000 Government Center Parkway, Suite 433 Fairfax, VA 22035 703-222-8435 www.fairfaxcounty.gov/consumer

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