Medical ID Theft Threatens Unsuspecting Victims' Lives

Linda Weaver first became aware that her medical information had been stolen when she received a bill for a surgery she never had.

"I found out through my bills that someone had used my medical information for a foot amputation," she said. "I went to the hospital. I said I got two feet, it's not my bill. They said, 'That's your responsibility.'"

Frustrated by the hospital personnel's reluctance to help, Weaver threatened to sue.

"Only then did they show interest," Weaver said. "The hospital dropped the bill, but other bill collections agencies started going after me. The doctor's bills are not being dropped. My insurance company won't pick up any of it because it wasn't me."

"I could never get [those fraudulent charges] off my credit report," Weaver said. "So you just say screw it, your credit's ruined. I've resolved myself to the fact that I'll never get a decent interest rate for anything."

Although her credit was ruined, Weaver was confident that her medical records had been corrected. However, an emergency visit to the hospital for a heart attack proved that was not the case.

"Supposedly my medical record had been purged, but the nurse thought I had diabetes when in fact I don't," she says. "These kind of mistakes could be fatal."

Thieving Doctors Deceive Patients, Insurers

Massachusetts resident Debra Herritt became aware of the fraudulent use of her medical identity when her psychiatrist, Richard Skodnek, was arrested in April 1994.

"I didn't know before I saw him in the paper," Herritt said. "I had no idea what extent [was the fraud] because the insurance company never let me know when they had paid a claim, and we were paying him out of pocket. He double-dipped. Billed me, then the insurance company, for dates he hadn't even seen me."

The problem was more extensive than Herritt thought.

"After I met with a man from the FBI, I found out that he had also billed the insurance company for seeing my children and he had never even met my children," she said.

Since Skodnek's conviction, Herritt has asked her insurance company to remove his psychiatric diagnoses from her children's medical records.

"It was an incredible invasion of our privacy," she said. "My children were not the only children of patients he did that to, that he gave fraudulent diagnoses. I really don't know if the system has changed so that there is more oversight or what they've done."

'Like a Visa Card With a $1 Million Spending Limit'

Byron Hollis, national anti-fraud director of the Blue Cross and Blue Shield Association, explains that the rising number of medical-identity theft reports is an industrywide problem.

"An insurance card is just like a credit card with a $1 million spending limit," he said. "In the wrong hands, it could be devastating."

Hollis says that Blue Cross and Blue Shield and other insurers recognize the problem and are taking steps to protect consumers.

"Social Security numbers used to be used as a person's insurance number," Hollis said. "We have removed Social Security numbers from people's insurance cards. Now a randomly generated number is assigned to people as ID."

Health Plan Program Specifically Targets ID Theft

The Regence Group, the largest affiliation of health-care plans in the Pacific Northwest, has developed a program specifically targeting medical-identity theft.

"When a member reports a stolen health-care card, that information is entered into a computer and our special investigative unit and pharmacy services are notified," said Samantha Meese, a spokeswoman for Regence. "The member is then issued a new card. This puts up the necessary red flag, and we're alerted right away,"

The University of Connecticut Health Center also changed its policies in an effort to fight medical-identity theft.

The center had been paying for the health-care services of a patient under an assumed name for 15 years, says Mary Whalen, assistant vice president of ambulatory services at the University of Connecticut Health Center.

The administration realized the fraud only when the patient confessed six months before he died last year.

The discovery prompted the health center to change its policies.

"Two hundred cases a year are uncovered, but that says nothing about those undiscovered," Whalen said. "We now ask for different forms of ID. If a person does not have an ID and it's not an emergency, our managers are instructed to turn people around."

"We've got people saying that they forgot their ID in their car. They leave and never come back. So we're suspicious about them," Whalen said.

The University of Connecticut Health Center also has a high-technology plan to protect patient identity.

"We plan to have electronic records in March. The hospital and physicians' offices will all share the same database," Whalen said. "We'll be scanning papers, insurance cards and IDs. When a person shows up, we'll be able to type in their name and a picture will show up on the computer screen. We'll compare that picture with the photo ID they'll present to us. We have a very significant firewall making it very difficult for hackers to get into the system."

Too Late to Fix Once the Problem Is Found

Experts agree that consumers must take the initiative to protect their medical identity.

Pennsylvania Attorney General Tom Corbett explains that people often realize that their medical information has been stolen only after the harm has been done.

"People don't look at their EOB [explanation of benefits]. They say, 'Yeah, yeah, yeah,' and throw them in a pile," Whalen said.

But those forms are key to the protection of your identity, Corbett said.

"If you don't understand the forms, then you need to ask someone to explain," he said. "You want to correct any erroneous information in your files."

"Don't leave your medical benefit card behind. Protect it like you would your Social Security number. Never give out medical information to telemarketers. And if it happens to you, tell your health-care provider and let law enforcement know."

Snowball Effect

Although medical-identity theft often goes undetected, the World Privacy Forum estimates that potentially 3.25 million people are victims.

Linda Weaver warns there is "no way to protect yourself" if your medical information is stolen.

"Help yourself. Prove it's not you," she said. "It's going to take more people getting screwed like this to get things done, until the federal government cares enough to get a law out there."