If you discover that someone has used your healthcare information, medical records, or insurance benefits without your authorization, the most important thing to do is report the incident to your insurance company, request copies of your records, dispute fraudulent charges, and contact your providers to ensure records are corrected. Taking these steps can help protect your medical records, prevent the denial of claims, and reduce the risk of future insurance disputes. The following blog explores what you should know about these matters, including the importance of working with a San Diego County medical identity theft lawyer to explore your legal options and help you fight for the best possible outcome.
What Is Medical Identity Theft and How Does It Happen in San Diego County?
Medical identity theft occurs when someone uses another person’s sensitive information to obtain medical care in their name using their benefits. For example, someone may see a medical provider under your name or obtain prescription medication using your insurance information.
Generally, this form of identity theft is the result of a data breach in which someone accesses a medical center or patient records without authorization. Unfortunately, health care facilities and medical providers in San Diego and throughout Southern California are often targeted because they may not implement strong security measures to protect their files. However, medical identity theft can also result from physical theft, like that of a wallet or mail.
This form of identity theft is often the most dangerous, as it can impact your health records. As such, the fraudulent information included in your medical records can impact your future care, which may potentially lead to treatment errors as a result. This can lead to prolonged issues, injury, and in serious cases, death.
Common Ways Medical Identity Theft Occurs
- Healthcare data breaches can expose patient records
- Stolen insurance cards or policy numbers
- Theft of mail containing plan information
- Phishing emails that target healthcare information
- Fraudulent use of Medicaid or Medicare benefits
- Identity theft following healthcare cyber attacks
- Unauthorized patient record access
Why Medical Identity Theft Is Different From Financial Identity Theft
- Medical identity theft can have permanent impacts on your medical record
- Incorrect diagnoses may be added to your records
- Insurance benefits can be exhausted
- Victims often face both financial and health-related consequences
- Allergies, medications, and procedures may be recorded
- Future treatment may rely on false information
What Are the Signs My Information Is Compromised in San Diego?
Understanding the signs that your medical information may have been compromised is critical, as it allows you to take immediate steps to ensure the accuracy of your medical records while also fighting fraudulent charges and bills.
Generally, one of the most common signs that someone has used your information for medical purposes is if you begin receiving bills from a doctor you’ve never visited or are charged for procedures you’ve never received. This is also the case in the event that an insurance claim is denied because you’ve already reached your maximum benefits for the year.
You may also learn of medical identity theft through inaccurate information on your medical records. If there is information like allergies, medications, or surgical procedures that you don’t recognize, it may be a sign that someone has used your name to obtain medical care in your name.
Quick Signs of Medical Identity Theft
- Getting medical bills for treatment you haven’t received
- Receiving collection notices from healthcare providers you have never seen
- Insurance claim denials due to exhausted benefits
- Unexpected Explanation of Benefits (EoB) statements
- Medical records containing unfamiliar health information
- Notices regarding treatment at facilities you’ve never visited
Why Early Detection Matters
- Helps preserve your insurance benefits
- Prevents additional fraudulent medical claims
- Reduces the risk of medical record errors
- Allows healthcare providers to correct records sooner
How Do I Report Medical Identity Theft to My Insurance?
If you are a victim of medical identity theft in California, it’s important to understand how to report the theft to your insurance company. Generally, you should obtain all necessary documents, like your medical records, insurance policy information, and explanation of benefits, before calling your company’s fraud department.
You should note that under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to ensure the accuracy of your medical records. As such, you should contact all impacted providers after reporting the matter to your insurance company to rectify your records.
Step-by-Step Reporting Process
- Review your Explanation of Benefits (EoB) statement to identify unfamiliar claims
- Gather information to support your claim, like medical records and insurance information
- Immediately contact the fraud division of your insurance company
- Explain which charges, services, or claims are fraudulent
- Request your insurance company initiate a fraud investigation
- Ask for written confirmation of the report
- Contact all impacted healthcare providers and request copies of your medical records
- Review and identify any fraudulent or erroneous information in your reports
- File a dispute with your medical provider to have records corrected
- Monitor future insurance information to identify suspicious information
- Keep copies of all communications for future reference
When investigating medical identity theft, isnruance companies often evaluate unauthorized claims, inaccurate patient information, unsuual billing activity, duplicate treatments, and any evidence that another individual used your information.
Information to Gather Before Contacting Your Insurance Company
- Your health insurance policy information, including your insurance member ID number
- Copies of your Explanation of Benefits statements
- Provider names and service dates
- Copies of your medical records
- Identity theft reports, if already filed
- Notes, documenting all communications
What Additional Steps Should Victims of Medical Identity Theft Take?
Medical identity theft generally requires additional action beyond reporting the incident to your insurance company. Generally, victims in San Diego, Ocean Side, Encinitas, Chula Vista, and throughout San Diego County need to notify healthcare providers, dispute inaccurate records, report identity theft to government agencies, and monitor their credit reports for additional signs of fraud.
Unfortunately, medical identity theft frequently overlaps with healthcare data breaches, insurance fraud investigations, and consumer protection issues. In California, victims may need to contact insurance companies, providers, government agencies, and cosnumer protection attorneys to discuss fraudulent claims, and correct medical records.
Actions to Take
- Request copies of all impacted medical records
- Correct inaccurate information
- Report identity theft to the Federal Trade Commission (FTC)
- Review your credit reports for other forms of fraud
- Monitor future insurance claims
- Retain copies of all fraud-related correspondence
- Follow up with providers
Government Resources That May Help
- Federal Trade Commission Identity Theft Recovery Resources
- U.S. Department of Health and Human Services Offices for Civil Rights
- Centers for Medicare and Medicaid Services
- California Department of Justice Identity Theft Resources
Contact an Experienced Identity Theft Attorney Today
Medical identity theft can be incredibly difficult to navigate, which is why working with an experienced attorney with Barthel Legal is in your best interest. Our team understands how difficult these matters can be, which is why we are here to help you fight for the best possible outcome. When you need help, connect with our firm today to learn more about your rights.
