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AN OVERVIEW OF MEDICAL IDENTITY THEFT INV. CHRIS KOBER #346 NEBRASKA STATE PATROL Disclosure of Conflict of Interest This presenter has no significant financial interest/arrangement with any organization that could be perceived as a real or apparent conflict of interest with the subject matter of the presentation. OBJECTIVES Identify the methods of obtaining personal information used to perpetrate medical identity theft. Discuss impact of medical identity theft. Apply preventive measures and techniques to reduce the risk of medical identity theft. Medical Identity Theft Medical identity theft occurs when someone uses an individual’s name and personal identifying information to fraudulently receive medical services, prescription drugs and/or goods, including attempts to commit fraudulent billing. Comparison “Regular” ID Theft Financial crime Goal to make money Medical ID Theft Information crime Goal is frequently to get services or drugs Can happen in a healthcare Usually only happens in a institution healthcare institution or office using medical data Results in a loss of money Can result in financial loss, as well as, loss of life and/or medical benefits Victim usually finds out fairly Victim may not know for a long quickly time Some Statistics You Should Know Medical ID theft has increased nearly 22% over the past year Medical ID theft increased from 3% to over 5% of all ID theft 2.4 millions victims of medical ID theft in 2014 Nearly 60% of victims know the suspect 60% of patients never review medical records for accuracy Some Statistics You Should Know Average cost of medical bills = $23,346 Average cost to correct = $13,500 Estimated over $56 billion in cost to victims of medical ID theft Fraudulent billing is most common form of ID theft within Medicare and Medicaid Stolen or lost electronic devices are a large source of information for thieves Some Statistics You Should Know Healthcare workers are most common source of theft within hospitals Only 40% of medical ID theft incidences are reported to law enforcement Average victims spends more than a year trying to correct medical ID theft and only 10% of incidences get fully corrected 80% of organizations responsible for maintaining medical records have reported data breaches VICTIM PROFILE 30% have employer-based health insurance and 23% are Medicare/Medicaid 51% have higher education, college or above 50% full time employment and 13% part time employment 52% had reported income below $50,000 with and overall average income of $69,500 3 highest geographic regions Northeast (19%), Mid-Atlantic (18%), and the Midwest (18%). TYPES OF MEDICAL IDENTITY THEFT Shared information. Intentionally provide information to a friend or family member due to no insurance or lack of adequate insurance coverage out of need for medical treatment. TYPES OF MEDICAL IDENTITY THEFT Stealing someone else’s information. Steal information through various means; data breach, phishing, mail theft, trash, electronic devices, wallet, ect, used to either receive services or obtain prescriptions for controlled substances. TYPES OF MEDICAL IDENTITY THEFT Altering own information. Change your own information by altering spelling of name, DOB, SSN, address, and insurance policy numbers, most commonly done to obtain prescriptions for controlled substances. TYPES OF MEDICAL IDENTITY THEFT Create fake Information. Simply create fake identity by creating a name, DOB, SSN, and insurance card most commonly done in order to obtain prescriptions for controlled substances. TYPES OF MEDICAL IDENTITY THEFT Fraudulent billing. Billing for services never rendered or up-coding services to a higher billing code in order to collect higher payments, also perpetrated by organized crime groups to collect money. TYPES OF MEDICAL IDENTITY THEFT Professional Identity Theft. Stealing identity of medical professionals to include name, business address, DEA number, and prescription pad format, most commonly in order to obtain controlled substances. RISKS OF MEDICAL IDENTITY THEFT Improper medical information. Record could include wrong blood type and medication allergies which could have deadly consequences. Record could also included diagnosis such as mental illness which could have far reaching and damaging effects that could follow you throughout life. Improper medical information throughout entire network and electronic records database. RISKS OF MEDICAL IDENTITY THEFT Loss or denial of benefits. Cancellation of insurance, maximum benefit caps, and denial of life insurance due to information contained in medical record. Professionals may not receive payment for services rendered to ID thieves. RISKS OF MEDICAL IDENTITY THEFT Miss or missed diagnosis on the basis of the wrong information. Professionals could potentially overlook initial diagnosis information due to medical records indicating procedures having already been completed such as appendix or gall bladder removed causing delays and possibly wrong treatment. RISKS OF MEDICAL IDENTITY THEFT Financial loss due to unpaid medical bills. In addition to the unpaid medical bills victims face issues with bill collectors, loan or mortgage denials, higher interest rates, higher insurance rates, lose of employment or denial of employment opportunities, and wage garnishment. Providers potentially never paid or having to return payments that were made for services. RISKS OF MEDICAL IDENTITY THEFT Loss or damage to reputation. Employer-based insurance, where information is given to employer. Embarrassment due to the disclosure of sensitive personal health conditions. Professions reputation damaged due to loss of confidence in provider by patients. RISKS OF MEDICAL IDENTITY THEFT Legal issues. Subpoenas for medical records in defense of cases. Failed drug tests by ID thieves resulting in legal issues for victims. Professionals being sued by victims for breaches of medical information and face sanctions or fines from government or regulatory bodies. RISKS OF MEDICAL IDENTITY THEFT Loss of time. Victims could spend months even years to try to get medical records corrected. Professionals could face sanctions or scrutiny from licensure and other regulatory bodies. WHY MEDICAL IDENTITY THEFT Desperation, need, or necessity Personal use or personal gain Pressure from friends, family, or significant other Love triangles Revenge WHY MEDICAL IDENTITY THEFT Disgruntled employees Malicious actions Blackmail – financial gain Just for fun or the challenge POTENTIAL PERPETRATORS Friends and family Neighbors Drug addicts Contract workers Entry level employees Temp staff or staffing services POTENTIAL PERPETRATORS Cleaning service staff Drug dealers Organized crime groups Medical professionals Hackers PREVENTIVE MEASURES Record and monitor access to systems. Restrict personal cell phone and camera use by employees. Strong information technology restrictions. Written medical identity theft policy and response plan. Establish monitoring of records for red flags. Sequestering method for incorrect information PREVENTIVE MEASURES Trust your instincts. Check identification, make sure it matches. (Photocopy license or ID card) Examine documents that are presented. Complete detailed intake sheet for every visit. (Currently seeing any doctors or taking any medications?) Do not provide any information to patient. (Address, DOB, SSN, leading questions) PREVENTIVE MEASURES Take photo of patient or have video in clinic. Document identifying characteristics. (Scars, marks, tattoos, unique physical characteristics) Check with previous doctors. Check within your network and other networks. Check with pharmacy. (e.g., Walgreens, CVS, Wal-Mart, Target, Shopko, Bakers) Background check of employees. PREVENTIVE MEASURES Report suspicious patients and incidents. Examine explanation of benefits. Monitor insurance benefits. Check credit history. Check medical record. File police report AN OVERVIEW OF MEDICAL IDENTITY THEFT QUESTIONS ? Contact Information Investigator C. Kober#346 Nebraska State Patrol 2707 N 108th Street Omaha, NE 68164 402-964-7977 (office) 402-964-7976 (direct) 402-964-7979 (fax) 402-510-6207 (cell) 402-331-3333 (24hr) [email protected]
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