An Unhealthy Practice

March 27, 2007
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Victims of medical identity theft can get stuck with bills for care they didn’t receive.

They also can get stuck with someone else’s medical documents placed among their own medical records, which is even more costly and time-consuming than the medical bills, said Barbara VanPatten, a registered nurse and director of quality and risk management for Saint Mary’s Health Care.

“The hardest part and biggest burden for us is trying to straighten out the medical record,” said VanPatten. “Once your record has someone else’s information interspersed with yours, getting it out takes a long time. You have to trace it back to the lab, to radiology, so there’s not a history out there that includes someone else’s medical information.”

And that rogue data would haunt the victim at every hospital, doctor’s office, clinic, laboratory and other health care provider visited by the ID thief.

“If somebody presents at the hospital in my name and gets treated there, they now have a record with my name on it with this person’s medical information in it,” said Norbert Kugele, a Warner Norcross & Judd lawyer with an interest in privacy issues.

“He may have a different blood type than I do. Maybe he’s got diabetes and I don’t. There may be all sorts of differences. If I show up now … what if they give me the wrong blood type or they make decisions on me assuming that I’m a diabetic and I’m not? What if they give me insulin? There’s all sorts of potential problems that are posed by this problem.”

VanPatten said solving just one twisted medical record can take a long time.

“I’ve been in meetings that have lasted more than an hour where we have pored through medical records trying to piece out which kid had which care to make sure we have a clean medical record for each patient,” she said.

Why would someone steal another person’s medical identity? Mostly it’s to avoid medical bills, VanPatten said. Sometimes the “victim” actually offers to lend the fraudster a card for insurance, Medicare or Medicaid. Other times the ID thief wants to hide treatment for a condition that carries social stigma, such as a sexually transmitted disease, she said.

“People will do it because they’ve been reported for child abuse” and are trying to hide from doctors, she said.

“Sometimes there are people who will get themselves jobs in a hospital or doctor’s office where they have access to this information. They use it themselves or they’ll sell it,” Kugele said. “Sometimes they get it from stealing somebody’s wallet or purse.”

While it’s not a common occurrence, medical identity theft does happen, VanPatten said. Kent County Prosecutor Bill Forsyth said he does not recall any such cases locally. Matt Frendeway, a spokesman for state Attorney General Mike Cox, said that office most often chases cases involving nefarious employees of long-term care facilities who steal the identities of vulnerable adults.

Kugele said he’s seen incident estimates ranging from 500,000 to 3 million.

“I think we really don’t know because I think a lot of it has gone undetected, so it’s real hard to say,” he said.

The hospital usually doesn’t pursue fraud charges because the dollar amounts aren’t enough to justify criminal action, VanPatten said. The hospital classifies the costs as bad debt, she said. If someone shows up in the emergency room, the law demands the hospital treat the person without regard to their ability to pay, so the hospital would still pay whatever insurance didn’t cover, she noted.

More health care providers are asking for photo identification, such as a driver’s license, along with the insurance card, VanPatten said. Patients should protect their insurance cards as if they are cash, she added.

“Hospitals and health care providers are starting to think about this a little bit more,” Kugele added. “They should certainly do something to verify the identity of individuals. I think if providers are checking for identity with a photo ID and things like that, it goes a long way toward stopping, uncovering the problem. If all they (require) is an insurance number, then it makes them very vulnerable to that kind of thing.”   HQX

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