Medical Identity Theft

Medical Identity Theft: What Is It And How Can You Prevent It?

Last updated on May 11, 2021

Medical identity theft affects millions of Americans per year and is increasingly popular among criminals. It is a crime that can do a great deal of damage to the victim. Of all identity theft crimes, it is the least documented and studied, and unfortunately, can be the hardest to bounce back from, as victims have limited rights. Medical identity theft, a subset of healthcare fraud, leaves individuals with false information within their medical records that can affect their medical and financial lives for years to come.

Medical Identity Theft Definition

According to Pam Dixon, executive director of The World Privacy Forum,

“Medical identity theft occurs when someone uses a person’s name and sometimes other parts of their identity – such as insurance information — without the person’s knowledge or consent to obtain medical services or goods, or uses the person’s identity information to make false claims for medical services or goods. Medical identity theft frequently results in erroneous entries being put into existing medical records, and can involve the creation of fictitious medical records in the victim’s name.”

Medical identity theft is not only financially dangerous to victims but can also have life-threatening implications. If it so happens that the criminal’s health information is mixed with your own medical records, then it can affect your health insurance, treatment, payment records, and credit report. Not only can medical identity theft be disastrous, but it can damage your credit rating and it also wastes taxpayer dollars.

The Solution to Medical Identity Theft

Turning to professional help is nothing new when it comes to fighting identity theft. One of the best services in this field is Identity Guard. This service works by monitoring your identity to see whether any of your information comes up somewhere that it shouldn’t, using IGM Watson artificial intelligence to do so.

With a lot of stolen medical records ending up on the Dark Web, Identity Guard regularly watches this part of the internet for any of your information. Should any suspicious activity turn up, you are automatically notified via either email, text message or phone call. Other features offered by Identity Guard include a risk management report, safe browsing tools, custom apps for iOS and Android devices, an anti-phishing mobile app, address monitoring, social insight report, antivirus and firewall software, keystroke encryption when you are online, and a three-bureau credit report with quarterly updates.

If you are ever a victim of identity theft, Identity Guard supplies users with up to $1,000,000 in insurance covering any lost wages, legal fees, travel costs, and even child care.

Is Medical Identity theft the same as HIPAA?

You might be wondering, what is HIPAA?

“HIPAA stands for Health Insurance Portability and Accountability Act. Passed in 1996 HIPAA is a federal law that sets a national standard to protect medical records and other personal health information.

The rule defines “protected health information” as health information that:

  1. Identifies an individual and
  2. Is maintained or exchanged electronically or in hard copy.

If the information has any components that could be used to identify a person, it would be protected. The protection would stay with the information as long as the information is in the hands of a covered entity or a business associate. The protections apply to individually identifiable information in any form, electronic or non-electronic. The paper progeny of electronic information is covered (i.e. the information would not lose its protection simply because it is printed out of a computer), and oral communications are also covered.”

While a mandate to comply with HIPAA exists, many healthcare providers do not as a lot of practitioners feel it is either inconvenient or tedious.

Medical Identity Theft Victims are Likely to Experience:

  • Changes to their health care records (includes falsified information or improper billing).
  • Large bills for medical treatments they never asked for or received.
  • Problems with insurance caps.
  • Long-term problems with credit due to debt collectors reporting debt based on medical identity theft.
  • False accusations (including drug use, with some individuals even having their children taken away due to false entries in their medical files).
  • Financial impacts (due to medical identity theft debts, some people are unable to qualify for a mortgage, etc.).
  • Sales of medical debt from identity theft can heighten a victim’s debt collection and credit complications, though no fault of their own.

Why Your Medical Identity is so Valuable?

Sometimes, your medical records might hold more value than your credit card number. There are several reasons for this:

Access – When compared to high-risk institutions like banks and credit card companies, hospitals have moderately low security. There is an added security risk in protecting your privacy as there is no central repository for medical records.

Data – Your medical records include much more sensitive information than your bank account does. This includes things like names, diagnostic codes, insurance policy numbers, and billing information. This allows criminals to create fake identities, purchase drugs, and medical equipment and file false insurance claims.

Timing – Credit card theft is fairly simple and quick to uncover with compromised accounts canceled quickly. On the other hand, people do not regularly check their medical records and it takes time to uncover medical identity theft.

Value – Medical identities can be worth up to 20-50 times more than financial identities.

Latest Medical Information Leaks Uncovered

Who Commits Medical Identity Theft?

Hackers – In 2014, the Affordable Care Act’s website was hacked by Chinese identity thieves using the Heartbleed security flaw stealing valuable personal data.

Personnel – Employees including doctors, lab technicians, and nurses all have easy access to your medical information, and with their knowledge of insurance billing systems it is an effortless way for them to make a quick profit.

“A Boston area psychiatrist made false entries in charts of individuals who were not his patients. He gave individuals diagnoses of drug addiction and abuse, severe depression and numerous psychiatric sessions which they did not actually have, then used their personal information to submit false bills to insurance. The victims, after learning of the crime, had difficulties getting the false information removed from their medical files. One woman told an investigator that she “is concerned about obtaining future health insurance coverage … because her husband is self-employed.”’

Organized Crime Rings – Crime organizations are able to purchase stolen patient information either on the Dark Web or other black markets and create fake clinics.

The Victims Themselves “Knowingly allowing a friend or relative to use your medical insurance is illegal, an act of fraud against insurance companies and health providers. And wrongfully sharing Medicare or Medicaid benefits is a crime against the federal government and state programs.” However some people do it as a Robin Hood-type crime, thinking that nobody will get hurt, and if they can they will help them out. Unfortunately, the do not understand that the cost which burdens insurance companies and healthcare providers most often ends up back with the consumer.

Dixon is of the belief that many such crimes take place on the inside.

“Medical identity theft is primarily an inside job perpetrated by employees with legitimate access to patients’ medical records. There is an average $1 million to $2 million payout per crime ring activity. Since much medical identity theft goes unnoticed and unreported, her best guess for how extensive the problem indicates that 2.5 to 3.5 percent of all identity theft is medical identity theft. Regrettably, there is little that the average consumer can do to protect himself from this form of theft, but some corrective measures are possible. The public must keep their medical insurance cards in a safe place. Insurance cards should be treated as one would treat a bank card.”

The insider threat is inarguably ever-present with often open opportunities for personnel to access these files constantly, even if they do not have the authorization to do so. Although it cannot be eliminated entirely, there are measures that can be taken so as to decrease the risks of this happening. Upon hiring staff, potential candidates should be screened with criminal background checks.

“However, few cases of medical identity theft resulting from the theft of an insurance card. This form of theft occurs on a large scale in hospitals, doctors’ offices, clinics and pharmacies without the patient ever knowing it is happening. A hospital you’ve never been in could be charging your insurance company for a surgery you never had. Unless you read every explanation of benefits notice sent to you and question every charge, you may never notice that a crime has occurred.

Moreover, although you may eventually be able to recover your credit financially, due to HIPAA regulations, you may never be able to correct your medical record. The HIPAA (Health Insurance Portability and Accountability Act) enacted a privacy rule to protect patients from unauthorized access to their personal medical information, but that same rule can also make it difficult to remove erroneous information from a medical record. When one considers the possible medical safety issues resulting from incorrect medical information in one’s medical record, such as incorrect blood type, drug interaction and allergy information, erroneous information could be life-threatening,” says Dixon.

The Consequences of Medical Identity Theft

Physical Health Threat

While medical identity theft is a dangerous crime, it can also be life-threatening. Say if you were heading to the emergency room only to find out that your health insurance had been canceled, or worse still, getting misdiagnosed due to inaccurate information found on your medical records. The fact is, the criminal’s medical records can be mixed up with your own and include other information such as a different blood type or any medicines that you are allergic to.

‘“About 20 percent of victims have told us that they got the wrong diagnosis or treatment, or that their care was delayed because there was confusion about what was true in their records due to the identity theft,” says Ann Patterson, a senior vice president of the Medical Identity Fraud Alliance (MIFA), a group of several dozen healthcare organizations and businesses working to reduce the crime and its negative effects.

Invasion of Privacy

This is fairly obvious, but as with other data breaches, any information found on your medical records isn’t something you want to be shared with the world.

Legal Trouble

There have been recorded cases where a pregnant woman stole the medical identity of another female, delivering a baby who tested positive for illegal substances. The victim, who is also a mother, experienced social workers attempting to take her four children away believing that she was an addict. The victim had to hire a lawyer in order to keep her family in one piece.

Ruined Credit

Medical identity thieves are often known to accrue significant bills to your name and make a run for it before anyone notices. This could result in you being hounded by collection agencies, forced to pay higher interest rates or even get turned down for various loans or job applications.

Protecting Your Medical Information

  • Always protect your Social Security number. This critical piece of information can be used to steal your medical identity.
  • Always read your benefit letters as if they are bank statements.
  • Monitor when and to whom you provide your personal information, whether in person, over the phone or online. Also, you should always ask as to whether it is necessary to give your medical information.
  • Keep both paper and electronic copies of your medical records and health insurance records. When those records are no longer of use to you, shred the documents (never throw them out as they are).
  • Never post any information about upcoming medical surgeries on social media platforms like Facebook, Twitter or Instagram. You cannot be sure who is monitoring your online movements.

Where Medical Identity Theft is Most Prevalent

In The Geography of Medical Identity Theft, Pam Dixon and John Emerson looked into where such crimes are prevailing in the United States.

“This data reveals complaints about overall patterning of medical identity theft with significant concentrations in Northern and Southern California, Phoenix, Arizona, Chicago Illinois, many cities throughout Florida, but especially cities in South Florida, and a strong distribution of complaints throughout the eastern seaboard. Some dispersed city-level hotspots appear in Denver, Colorado, the Vancouver-Portland metro area, Seattle, and the largest cities in Texas. Of the states, North Dakota had no complaints for this time frame.”

What’s worse about crimes like this is that most of the time, children are hit the hardest, and it takes years until this information is uncovered.

“Unfortunately, it’s the kids that can be the most affected by medical identity theft. They often don’t find out about it until they get out on their own and begin to apply for health insurance or as they get older, life insurance.  The premiums they encounter as a result of an earlier medical identity fraud can be among the highest available and often take years to straighten out,” says Robert Siciliano, Online safety expert for Intel Security.

Other people that are most at risk are new mothers, people with chronic conditions like diabetes, surgery patients, or those that suffer from serious illnesses like cancer. The truth is, the more interaction you have with the healthcare system, the bigger the opportunity for your records to be taken advantage of.


The number of cases of medical identity theft is on the rise, not only in the United States but all over the world. Thieves are attempting to get their hands on people’s private information in order to gain access to medicine or make claims against their health policies. With just the information like your Social Security Number, your medical and personal information can be up for sale on the black market in a flash.

People should be on the lookout for invoicing for fraudulent treatment, which happens when criminals bill you for fake treatment, with the disappointing possibility that people who are employed to help you, like doctors and nurses are possibly in on the scam.

Medical identity thieves can also use your medical information to purchase illegal drugs or receive free treatments. This might result in you losing your health coverage, ruining your credit history, creating false records, and even high premiums.

In order to fight back, you can look into identity protection services such as Identity Guard, which will be constantly on the lookout for any suspicious activity regarding your personal information. Using artificial intelligence, Identity Guard will instantly notify you if your personal information ends up anywhere that it shouldn’t.

Additionally, you should look closely at your Explanation of Benefits from your health insurance company, as well as checking your medical records regularly. Never share information about upcoming surgeries and if you have children, and keep a keen eye on their medical information as well.


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