10 Warning Signs Of Medical Fraud And How To Protect Yourself

Health insurance is intended to ensure individuals and families have access to essential treatments, preventive services, and emergency care. However, it appears that it has also become a lucrative target for scammers.

In February of this year, Change Healthcare experienced a cyber-attack that affected thousands of healthcare providers, insurers, and policyholders across the nation. Reports indicate that approximately 50% of all US medical claims could be compromised. To put this into perspective, if you're in a waiting room with nine other people, there's a significant chance that five of you could fall victim to medical identity theft within the year. The fallout from this fraud is immense, disrupting countless individuals' access to healthcare. Once your medical information is exposed online, identity thieves can use it to file fraudulent claims, purchase expensive prescriptions, and more—all charged to your account.

The most alarming aspect is how some people discover they have been affected. Some face tax or mortgage fraud, while others visit the doctor only to receive a rejection letter from their insurance provider, stating that their benefits have been exhausted due to multiple procedures they never had. This is because someone stole their medical ID and used it for their own treatments.

It's not just individuals at risk; manipulative organizations can exploit your medical information for fake billing schemes. They submit fraudulent claims for medical services you never requested or received, then collect their payday and leave you with the bill. In July, 193 defendants, including 76 doctors, nurse practitioners, and other licensed medical professionals, were charged for their alleged involvement in various healthcare fraud schemes that resulted in $2.75 billion in false billings to federal programs. Medical fraud is a real and pressing issue.

How Do You Know If You're A Victim?

Here are 10 signs that your medical ID may have been stolen and is being used by cybercriminals:

1. Unexpected Medical Bills: Receiving bills for medical services you didn't receive is a major red flag.
2. Collection Notices: Being contacted by debt collectors for unpaid medical bills that aren't yours.
3. Errors In Medical Records: Finding inaccuracies in your medical records, such as treatments you never had, incorrect diagnoses, or unfamiliar medical histories.
4. Insurance Issues: Your health insurance claims are denied because your benefits have been maxed out, or you're told you've reached your coverage limit despite not using the services.
5. Notification From Your Insurance Provider: Receiving alerts from your health insurance provider about claims or services you don't recognize.
6. Unknown Accounts: Discovering new health insurance accounts or medical records under your name that you didn't create.
7. Discrepancies In Your Explanation Of Benefits (EOB): Your EOB statements from your insurer list medical services you didn't receive.
8. Being Denied Insurance: Having difficulty obtaining life or health insurance because medical conditions that you don't have are listed in your records.
9. Calls From Medical Providers: Receiving calls from doctors or medical facilities about appointments or follow-ups for treatments you never had.
10. Unfamiliar Prescriptions: Notices about prescriptions being filled in your name that you did not authorize or receive.

How Can You Prevent Becoming A Victim Of Medical ID Fraud?

Don't become the next medical ID theft victim. Here are a few steps you can take to protect yourself:

● Check For Health Care Breaches: Use a searchable database, like this one, to find out if your health care information has been compromised.

● Secure Your Records: Store paper copies of medical records in a safe or lockbox to prevent unauthorized access. If your health care organization's system is compromised and records are lost, altered or unable to be accessed, you will be glad you did this.

● Shred Documents: Shred any documents with personal information before disposing of them.

● Monitor Your Medical Records: Regularly request and review your medical records from your health care providers and look for unfamiliar treatments, diagnoses or other discrepancies.

● Review Insurance Bills: Carefully review explanation of benefits (EOB) statements from your insurance provider for any services you did not receive and question unfamiliar or unclear charges. Contact your insurer immediately if you see any charges or services that you don't recognize. Afterward, report any billing errors to the credit bureaus at IdentityTheft.gov.

● Dispose Of Prescription Labels: Remove labels from empty prescription bottles before discarding them! These labels can contain information that, believe it or not, can be used to steal your identity.

● Monitor Your Credit: At AnnualCreditReport.com, you are able to get three free reports a year to keep an eye on any suspicious activity.

Health care will always be around and will also always be a target for hackers. Attacks on hospitals, doctors' offices and other medical facilities will continue. It's important that you are taking proactive measures to protect yourself. We can help you find out how you're at risk with our FREE Discovery Call. To book your Discovery Call, call us at (951) 742-8020 or click here.