1. society
2. crime
3. property crime
4. larceny

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
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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
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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
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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
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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
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WHY MEDICAL IDENTITY THEFT
Disgruntled employees
 Malicious actions
 Blackmail – financial gain
 Just for fun or the challenge
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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
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PREVENTIVE MEASURES
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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
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Trust your instincts.
Check identification, make sure it matches.
(Photocopy license or ID card)
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Examine documents that are presented.
Complete detailed intake sheet for every
visit.
(Currently seeing any doctors or taking any medications?)
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Do not provide any information to patient.
(Address, DOB, SSN, leading questions)
PREVENTIVE MEASURES
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Take photo of patient or have video in clinic.
Document identifying characteristics.
(Scars, marks, tattoos, unique physical characteristics)
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Check with previous doctors.
Check within your network and other networks.
Check with pharmacy.
(e.g., Walgreens, CVS, Wal-Mart, Target, Shopko, Bakers)
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Background check of employees.
PREVENTIVE MEASURES
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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]