Local Doctor Weighs in on Medical Identity Theft

Editor’s Note: Wilmington doctor Jill Brooks, M.D., writes about the importance of keeping tabs on your healthcare provider to prevent the rising problem of medical identity theft.

Medical identity theft continues to be major problem in the U.S. with approximately 2.32 million adults or close family members falling victim in 2014. According to the Fifth Annual Study on Medical Identity Theft by the Ponemon Institute, medical identity theft is on the rise with a 21.7% increase since last year.


Source: Ponemon Institute Feb. 2015

Some attribute this rise to the use of Electronic Health Records while others focus more concern on insecure websites, databases and health information exchanges as a result of the Affordable Care Act.

Medical identity theft includes use of the information for fraudulent billing purposes or to obtain medical services, pharmaceuticals or durable medical equipment. Although most of medical identity theft occurs without the victim’s knowledge, medical identity theft also includes the intentional sharing of one’s own health insurance information for others to also use for their benefit.

Source: Ponemon Institute Feb. 2015

Source: Ponemon Institute Feb. 2015

The vast majority of those who willingly share their insurance information did this to help a family member or close friend who did not have insurance, could not afford the treatments or in an emergency situation.

More than two-thirds of the Ponemon survey respondents were not confident about the security measures in place by their healthcare provider to protect their medical records. About half of all responders stated they would change healthcare providers if they were made aware of a data security breach. The actions found to be most important to those notified of a breach include how the victim would be reimbursed for prevention of future damages, timeliness of the notification and provision of identity theft protection.

Unfortunately, the resolution of medical identity theft takes a long time and may be very costly to the victim. Prevention is key. A protective measure by the healthcare provider is to continually monitor the accuracy of the medical record which may involve the individual reviewing hard copies of their medical record periodically or via a patient portal as well as stressing the importance of reviewing their Explanation of Benefits.

jillbrooksJill Brooks, M.D., is Director Of Education at First Healthcare Compliance in Wilmington.


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1 Comment

  • Medical Fraud is impossible without Doctors or if you prefer, Physicians, why is it they are allowed to continue to practice after being convicted. No one is breaking into or searching trash cans for medical records, it comes from dishonest Physicians practices who use the identities to file false claims and accept the insurance payment, the patient is never aware.