MEDICAL BENEFITS FRAUD - A GROWING CRIME TREND WITH UGLY CONSEQUENCES TO THE VICTIM

With rising health care costs KnightsBridge Castle has been tracking an alarming increase in medical benefits fraud. Recent trends in identity theft indicate that we are seeing a new and highly effective form of fraud.

Medical benefits fraud involves the use of your medical benefits and insurance by an identity thief. Stolen Social Security Numbers (SSN) and date of birth can facilitate the crime, however most hospitals, emergency rooms, or health care providers, need only a name and address. The insurance industry and the payment systems of these health care providers make it easy for them to locate your health coverage plan with a minimum of data.

Health care providers are primarily concerned with the immediate delivery of service. This is particularly true of emergency rooms and urgent care facilities. In an urgent care facility, treatment is primary, and billing is left to someone working a desk who needs only minimal information to satisfy the institution’s billing needs.

Detection of this crime is usually the arrival of a bill for co-payments and non-covered medical expenses. This is frequently followed by demands from collections. Eventually these false charges may show up on your credit records. Recovery from this identity crime is very complex and fraught with unique obstacles to remediation.

Under HIPPA (Health Insurance Portability and Accountability Act) medical service providers are under rigid procedures for the access to health records. Although the experiences of Eric Drew, founder of KnightsBridge Castle, show the ready availability of stolen health records within medical institutions, attempting to acquire health records to recover from identity theft is extremely difficult.

Although the medical records of victims of medical benefits fraud may contain your name, SSN, insurance information, and other identifying information about you, medical service providers will not give you a copy of the file if you claim medical benefits fraud. Why? HIPPA requires medical providers to protect the privacy of medical information, even if the medical service was provided to an imposter and identity thief.

Medical service providers do not have very efficient billing systems and their systems for correcting errors in their billing statements are primitive. Since the billing departments lack access to the medical file it takes extraordinary efforts to have a false bill reversed.

This has led to some absurd situations when victims confront medical billing systems. One example had the victim showing his scar-less knees to a billing clerk and demanding a reversal of a bill for knee replacement surgery. The demand fell upon deaf ears.

Medical insurance information brings top dollar on the street. Even identity thieves need health care, and rather than pay for it they choose to apply their impersonation tools to filling this critical need. However, medical benefits fraud now extends beyond urgent care and now has been detected in fraud for elective procedures and even cosmetic surgery.

As we so often repeat on this blog, identity theft is not just about credit theft. Its about 80 crimes of credit fraud, impersonation crimes, and criminal identity theft. Medical benefits fraud is just another example of how you can be defrauded, with ugly consequences, and is an example of a crime in which credit monitoring or credit card insurance will prove of no value.