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A service of the Investigators of Kroll Fraud Solutions


These materials are derived from the research and discovery activities of Kroll Fraud Solutions’ Fraud Specialists and Licensed Investigators, and have been gathered from personal, historical, and aggregated
experience performing specialized restoration services on behalf of Identity Theft victims. While believed to be accurate, these materials do not constitute legal advice, and are not guaranteed to be correct,
complete or up-to-date. No part of this document may be reproduced, transmitted, transcribed, stored in a retrieval system, or translated into a language or computer language, in any form by any means,
electronic, mechanical, optical, chemical, manual or otherwise, without the express written consent of Kroll Fraud Solutions. These materials are provided for informational purposes only.
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Medical Identity Theft
Overview: A brief description of medical identity theft


Medical identity theft results from the fraudulent use of an individual’s personal information, Social
Security number, or health insurance information to obtain medical goods and services, money
through insurance fraud, or insurance coverage for treatments. This may result in a number of
problems for the victim which might include a collection account for a past due bill, medical
insurance filing errors, or distorted medical records that could affect future medical treatment.
Medical identity theft is one of the more complicated and problematic types of identity theft
that can occur. The reasons for these complications are mainly attributed to the lack of a central
repository of medical history and the extensive privacy laws in relation to medical file disclosure.
It is difficult to discover and the fraud may exist until uncovered through a myriad of methods.
Discovery: Ways an individual might discover medical identity theft
Some of the ways victims discovered their personal information was used by another person for
medical purposes include:


n Receipt of an Explanation of Benefits statement from your health insurer listing services or
treatments that were never provided.
n Receipt of a bill for services or equipment that were never provided.
n Collection account listed on a credit report that is the result of an unpaid medical bill not
related to any valid services provided.
n Denial of health insurance or notice of increase in premiums based on a medical condition
that you do not have.
n Inaccuracy found in medical record held by physician or hospital.
n Alert received from a healthcare provider, law enforcement agency, or an insurance company
who has discovered the fraud.


Proactive steps: Early detection of medical identity theft
These steps may help detect signs of medical identity theft early and are instrumental in limiting
the amount of damage done by an identity thief.


n Review your health insurance provider’s Explanation of Benefits statement for any activity
that is not correct.
n Obtain your “benefits request” each year from your insurance provider. This is a listing of
benefits paid in your name by your health insurer. If you do not recognize any payments,
follow up with the insurer or provider to learn more.
Important Information about medical identity theft


INVESTIGATOR INSIGHT


A service of the Investigators of Kroll Fraud Solutions
These materials are derived from the research and discovery activities of Kroll Fraud Solutions’ Fraud Specialists and Licensed Investigators, and have been gathered from personal, historical, and aggregated
experience performing specialized restoration services on behalf of Identity Theft victims. While believed to be accurate, these materials do not constitute legal advice, and are not guaranteed to be correct,
complete or up-to-date. No part of this document may be reproduced, transmitted, transcribed, stored in a retrieval system, or translated into a language or computer language, in any form by any means,
electronic, mechanical, optical, chemical, manual or otherwise, without the express written consent of Kroll Fraud Solutions. These materials are provided for informational purposes only.


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n Request your medical records if you have any suspicion of fraud. You have the right to request
copies of records from any entity covered by the Health Insurance Portability and Accountability
Act of 1996 (HIPAA) that maintains information or is suspected to have information about you.
These organizations are subject to the HIPAA privacy rules and have an obligation to provide
you with your medical history.


n Request an “accounting of disclosure.” Under HIPAA, this is a list of any entities that have
received personally identifiable healthcare information for uses unrelated to treatment and
payment. These reports are available once every 12 months, free of charge.


n Order your annual Medical Information Bureau (MIB) report by calling 1-866-692-6901.
These reports provide information regarding underwritten life, health, or disability income
insurance and could indicate fraudulent insurance filings. Not everyone has a file with the
MIB. Note that, according to www.mib.com, only 20% of consumers have a record with the
Medical Information Bureau. The reports are available once every 12 months, free of charge.
Common types of health insurance fraud


n Medical Equipment Fraud: Equipment manufacturers offer “free” products to individuals.
Insurers are then charged for products that were not needed and/or may not have been delivered.


n “Rolling Lab” Schemes: Unnecessary and sometimes fake tests are given to individuals at health
clubs, retirement homes, or shopping malls and billed to insurance companies or Medicare.


n Services Not Performed: Customers or providers bill insurers for services never rendered by
changing bills or submitting fake ones.


n Medicare Fraud: Medicare fraud can take the form of any of the health insurance frauds listed
previously. Senior citizens are frequent targets of Medicare schemes, especially by medical
equipment manufacturers who offer seniors free medical products in exchange for their
Medicare numbers. Because a physician has to sign a form certifying that equipment or testing
is needed before Medicare pays for it, con artists fake signatures or bribe corrupt doctors to
sign the forms. Once a signature is in place, the manufacturers bill Medicare for merchandise
or service that was not needed or was not ordered.
Source: Federal Bureau of Investigation


Tips for avoiding health insurance fraud


n Never sign blank insurance claim forms.
n Never give a blank authorization to a medical provider to bill for services rendered.
n Ask your medical providers what they will charge and what you will be expected to pay
out-of-pocket.
n Do not do business with door-to-door or telephone salespeople who tell you that services or
medical equipment are free.
n Give your insurance or Medicare identification only to those who have provided you with
medical services.
n Keep accurate records of all healthcare appointments.
n Know if your doctor ordered equipment for you.
Source: Federal Bureau of Investigation

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