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A Better Partnership


Feb 2007
February 19, 2007

The Doctor Will See You Now

But Is It Really You He's Seeing?

We've read and heard a lot about identity fraud in the last few years. Most of these stories have focused on financial identity fraud, where a criminal obtains the victim’s social security number and racks up huge debt on accounts the criminal has established in the victim's name. One type of identity fraud that has not received as much attention is medical identity fraud, which not only has financial implications, but also has implications for the care provided to the victims of such fraud.

Medical identity fraud can happen in different ways, but one common scenario is when an individual shows up for treatment using someone else’s name and insurance information. The imposter may have stolen the information, bought it from a thief, or even be using it with the permission of a sympathetic friend or relative.

Like the more conventional financial identity fraud, medical identity fraud has financial implications. Doctors and hospitals render treatment that ultimately may not be reimbursed by insurers if the identity fraud is discovered. If it is not discovered, then those who foot the insurance bill (typically, employers and their employees) end up paying for services of uninsured individuals.

Aside from the financial implications, there are also ominous implications for treatment. If I am the victim of medical identity fraud, then someone else's medical information has made it into my medical record. The odds are that the imposter does not have the same blood type, drug interactions and medical conditions that I do. For example, if the imposter has diabetes (which I don't), this could broadly impact treatment decisions. If I have been involved in an accident and am taken unconscious to the emergency room of the hospital that treated the imposter, the emergency room doctors and nurses may end up making incorrect decisions about my treatment. What if they give me insulin, or a blood infusion of the wrong blood type?

Moreover, once the information gets into a medical record, it may get shared with other health care providers. The L.A. Times ran a story recently about a victim of medical fraud who found that an imposter's information not only was in her hospital's files but also ended up in the files of other doctors and even another hospital.

How big of a problem is this? It's hard to know. Using FTC Identity Theft Clearinghouse data from 2003, the World Privacy Forum estimates that the number of victims could range from a few thousand to over three million, but most likely has impacted a quarter to a half-million victims. While this may be a small percentage of the overall population, it is still a significant number of victims. With the growing number of uninsured in this country, however, the incidence of medical identity fraud is likely to increase.

Preventing medical identity fraud requires everyone to be vigilant. Doctors and hospitals need to verify the identity of patients in order to catch fraud before it occurs. All of us need to safeguard our personal information, and we should also carefully review explanations of benefits and invoices to make sure that they relate to medical services we actually obtained. And if you suspect medical identity fraud, you have the right under state and federal law to review your medical records to verify that the information is accurate. If the information is wrong, you will need to work closely with your health care provider to ensure that your record is accurate.

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Norbert F. Kugele is a partner in the Grand Rapids office of Warner Norcross & Judd LLP. He specializes in the areas of employee benefits and privacy, particularly with respect to health records and privacy issues relating to the Internet. He also counsels clients on computer, copyright, and e-commerce and intellectual property litigation. Norbert is Chair of the Firm's HIPAA Task Force and Cochair of the Firm’s Privacy and Information Security Task Force. He may be reached at 616.752.2186. Because each business situation is different, this information is intended for general information purposes only and is not intended to provide legal advice.

MiBiz West

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