What is Medical Identity Theft and How to Stop It

When you hear identity theft, you probably think about how your bank accounts, credit, and personal finance may be affected. However, identity theft can also affect your medical records, insurance, and Medicare. So, what is medical identity theft and how can it affect you?

What is Medical Identity Theft?

The Federal Trade Commission (FTC) defines medical identity theft as someone else using your name and insurance information to receive medical treatment, prescriptions, or surgery. Medical identity theft can also occur when someone else uses your information to submit false bills to insurance companies in order to collect the insurance money.

Unfortunately, medical identity theft affects many people. If you are a patient, identity thieves could be after your information. If you are a doctor or insurance company, identity thieves could be after the information of your patients. Now that we have answered “what is medical identity theft?” we can learn how to prevent it.

How To Identify Medical Identity Theft

Unfortunately, many people do not know that their medical information has been stolen until it affects their medical care, insurance, or health plans. Some common signs of medical identity theft are:

  • Receiving a bill, insurance statement, or credit statement for a medical treatment, service or visit that you did not receive
  • Receiving explanations of benefits (EOB) for medical treatment, service or visit that you did not receive
  • A debt collector contacting you about medical debt that you do not owe
  • Your insurance company saying that you have reached the limit of your benefits
  • Your insurance company denying your coverage because your medical record shows a condition that you do not have

How to Prevent Medical Identity Theft

Preventing medical identity theft is similar to preventing other forms of identity theft: protect your important information. This includes your full name, date of birth, insurance cards, prescription information, medical billing statements, explanation of benefits, and any other medical paperwork. Because most of these contain personal information, it is important to be careful with this information.

If you ever need to dispose of sensitive medical documents, it is important to shred or destroy the documents in another way. When disposing of prescription bottles, peel off the label and destroy it. If you cannot peel it off, completely mark out all sensitive information with a permanent pen or marker.

Also, check your mail as soon as possible each day. You can limit the chances of medical identity theft by ensuring that medical bills, insurance statements, and EOBs are not left in your mailbox for thieves to take. An even safer method would be to enroll in online or paperless billing, notifications, and EOBs.

What Should You Do If You Suspect Medical Identity Theft?

If you believe you are the victim of medical identity theft, it is important to act quickly.

  • Review your medical records: If you suspect identity theft, ask your doctor, clinic, hospital and pharmacy for your medical records. Review these documents carefully in order to identify what information may be fraudulent and where it originated from. If you find evidence of identity theft in your medical records, it would be wise to check other places for identity theft as well.
  • Review your credit reports: Request copies of your credit reports from each credit reporting agency (CRA). You can access your credit report once a year by going to Review this easy guide to learn how to report identity theft.
  • Report the Error: If you find evidence of medical identity theft, you need to report the error in two ways. Contact the three credit reporting agencies—Experian, Equifax and TransUnion—to report the theft. Contact these companies as quickly as possible. If you call, be sure to follow up in writing by certified mail, include copies of the medical records that indicate the errors, and request a response. Once you report medical identity theft with the CRAs, they will investigate the issue, including contacting your doctors, clinics, and insurance to verify the information. If fraud exists, the CRA, doctor, clinic, or insurance must then delete or modify the inaccurate information. It is also important to contact your creditor. Contact your creditor as soon as possible and notify them that your suspect medical identity theft. The creditor will advise you about what precautions and actions should be taken.
  • Place a freeze on your credit: A credit freeze restricts access to your credit. A doctor, clinic, or insurance company cannot continue to report information that may be connected to identity theft if there is a credit freeze in place. If they do, they are not following their obligations under the FCRA.
  • File an Identity Theft Report: The FCRA also allows you to file an identity theft report with the police. Submit copies of this report to the CRA and your doctor, insurance, or pharmacy to help notify them of potential fraud.
  • Know your rights under the FCRA: Doctors’ offices and insurance companies have the right to report any unpaid debt to the credit bureaus. However, they also have to follow the Fair Credit Reporting Act (FCRA) and ensure the information reported is accurate. If you dispute a medical bill with the CRA, the medical provider and insurance company must verify the debt they report and correct any errors.

How an Identity Theft Lawyer Can Help

If you are the victim of medical identity theft and your rights under the FCRA are being neglected, it may be time to call a lawyer. Identity theft lawyers work with victims of identity theft when companies, such as credit bureaus, doctors’ offices, and insurance companies, do not fulfill their obligations under the FCRA.  You should call an identity theft lawyer if any of the following happens to you:

  • You file an identity theft report with the CRAs, but your doctor, insurance company, or health plan fails to investigate
  • You set a credit freeze but a doctor, insurance company, or health plan continues to report fraudulent data to the CRA and that information remains in your credit report
  • You submit an identity theft report with the CRAs, with your doctor, insurance company, or health plan and they fail to correct your record when they cannot verify the accuracy of the debt in question

Each of these situations is a violation of the FCRA. A skilled identity theft lawyer will be familiar with the federal regulations surrounding the FCRA. If you are facing medical identity theft and your rights under the FCRA have been violated, it may be time to call a lawyer with experience in FCRA law.

The Financial Justice Initiative is a joint project between Schlanger Law Group and Terrell Marshall Law Group, whose attorneys have years of experience in FCRA law and in protecting consumers from identity theft. If you are experiencing medical identity theft, and you believe the CRA or your doctor, clinic, pharmacy, or insurance company is violating the FCRA, contact FJI to schedule a free case consultation.