Patients

• Carefully examine the Explanation of Benefits (EOB) sent to you by your health insurer. This document explains any services provided and the reimbursements for those services. Any unfamiliar claim should raise a red flag.
• Protect your health insurance information and safeguard your insurance card – keep it close to you and don’t leave it lying around.
• When checking in at a hospital or doctor’s office, make sure no one is listening in as you provide your personal information aloud.
• Obtain a free annual copy of your credit report. Most medical identity theft first shows up when the claim makes the transition to the billing department. If you have unpaid medical bill on your credit report, that is a major red flag.

What to do if you are a victim?

• Call your insurance company and ask for the fraud department.
• Call the police and report that you are a victim of medical identity theft.
• Contact your bank and credit card issuers and let them know that your medical identity has been stolen so you can start cleaning up your credit.
• Request access to your medical records from your health insurer and your health care provides.

Healthcare Providers

Under the guidance of Federal Trade Commission’s (FTC’s) “Red Flags” rule to prevent identity theft, healthcare providers now must implement processes to prevent, manage and mitigate the occurrences of identity theft.

The first step in preventing Medical Identity Theft is protecting the patients’ personal information that is used for ID fraud. HIPPA mandates healthcare providers securely exchange patient’s sensitive information, such as Social Security Number (SSN), during the registration process. Asking a patient to say his SSN out loud where people can hear the conversation is a violation of HIPPA regulation. The next step is to improving the accuracy of patient identification at the point of care. The Joint Commission lists “improve the accuracy of patient identification” as the top patient safety goal for 2011, and makes following recommendations:

• Emphasize with employees that the primary responsibility of health care works is to check and verify the identity of patients
• Use at least two identifiers to verify a patient’s identity upon admission or transfer to a facility
• Standardize the approaches to patient identification among different facilities within healthcare system
• Incorporate employee training on procedures for checking / verifying a patient’s identity into the orientation and continuing professional development for health care employees
• Educate patients on the importance and relevance of correct patient identification in a positive fashion that also respects concerns for privacy.

Many healthcare providers today require that patients provide photo ID at the time of registration. Although it is an important step in the right direction, a photo ID alone is no guarantee that patients are who they say they are. The Joint Commission recommends the usage of technology solutions in addition to the requirement of photo IDs and other proof of patient identity. A growing number of forward thinking healthcare providers made the vital decision to employ technology solutions that assist in accurate patient identification. Those technologies include use of biometrics, a method of identification based on a patient physical trait (what they are) as opposed to SSN (what they know) or photo IDs / insurance card (what they have.)