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What Is Medical Identity Theft?

Updated July 1, 2020 . AmFam Team

What's medical identity theft and are you at risk? Learn the definition, warning signs and how to protect against medical ID theft from American Family Insurance.

Medical identity theft can happen to just about anyone who’s had their identity stolen. And in some cases, medical identity fraud can occur — even without a data breach. How does medical identity theft occur? It happens when a thief illegally uses your identity to get medical care, prescriptions or receive payment for healthcare services under your name.

Medical ID fraud can negatively impact your medical record, your health insurance costs and eventually, your credit report. What should you do if you’re are a victim of medical identity theft? For starters, check your credit ASAP. Take a look at our other key suggestions to help keep your medical identity safe and secure.

Medical Identity Theft Warning Signs

Have you ever been told by your bank that your credit card number’s been stolen? When your personally identifiable information (PII) has been hacked, you may not be thinking about the safety of your medical ID, but perhaps you should be. Here are a few common warning signs that victims of medical identity theft report:

1. Your medical coverage statement is suspect

Your health insurance company sends you an Explanation of Benefits (EOB) for medical care you don't recognize or didn’t get.

2. You get bills for medical care you didn’t receive

A debt collector calls seeking payment for medical procedures, tests or drugs that you didn’t receive.

3. Your health care payout is suddenly maxed out

You get notice that your health coverage has reached its maximum benefit limit — and you know it hasn’t.

4. Your credit monitoring service informs you of a problem

If you’ve purchased a credit monitoring service, good job! They may reach out to you with details about a medical ID issue. For instance, if you pick up ID theft protection with American Family, our partner CyberScout will send you a credit monitoring alert when something’s wrong with your credit rating. They monitor your personal information and credit inquiries for signs of trouble.

5. Receipt of incorrect insurance information

You get a letter from your health insurance stating that a medical claim you never filed has been denied.

6. Denial of medical coverage for conditions you don’t have

You receive a denial of coverage statement from your health insurance group for a condition you don’t have.

7. You find unpaid medical debt in your credit report

Upon checking your credit, you find you’re in debt to unknown collection accounts.

Types of Medical Identity Theft Scams

Medical ID theft can come in many forms, but its effect on your finances can be a real problem for your good credit rating. This kind of fraud can even prevent or stall you from getting medical care when identity theft includes your medical records. Here’s a list of the common ways medical ID thieves scam their victims:

1. Fraudster impersonates the patient

At the doctor’s office, the ID thief will claim they’re you and may request to have the co-pay billed to you instead of paying at the time of service.

2. Drug-seekers pick up pain meds with your insurance ID

You may receive a bill from your local pharmacy or from an online source claiming that you purchased large quantities of drugs through your health plan. The identity thief may attempt to sell them on the black market.

3. Email requests your insurance info

You might get an email seeking your medical data like your insurance group, plan and member number. Scammers will send you a link and ask you to enter your info for the chance at winning a prize.

4. Fraudsters will call you and demand your health insurance data

Another common scam is unsolicited phone calls for health insurance information. In some cases, the scammers will have partial information, but not all of the data they need to steal your medical identity. They may tell you your address and zip code, but then they’ll ask for other key insurance information.

5. You receive an unsolicited call from Medicare

Fraudsters will pose as Medicare staffers seeking to verify your insurance data. Remember that Medicare personnel only reach out to you after you’ve contacted them.

Cost of Medical Identity Theft

There are many ways that medical identity fraud can wreak havoc on your life. You may need to prove your innocence to get your credit rating restored. And you can also lose access to healthcare if the fraud maxed out your annual benefit. Take a look at the ways medical insurance identity theft can impact you:

1. You may have to manage medical debt fraud

Even though you know you’ve done nothing wrong, debt collectors don’t know that. And you may find yourself harassed by collection agencies seeking payment for services you never received.

Here’s the good news: our identity theft protection service with CyberScout will pay up to $25,000 of protection to cover expenses related to a stolen identity. And they’ll take on the job of clearing your good name too.

2. Your credit score can take a hit

After a few unpaid billing cycles, your credit rating can begin to plummet. And if the fraud is big enough, you may not be granted funding for a home or auto loan, which can really throw a wrench in your plans.

3. You can be denied medical care

Victims of fraud may not be able to receive medical care. When the issue is severe enough, you may have to wait for medical care while creditors investigate the issue.

4. You’ll have to contact other parties affected by the fraud

Your personal time and energy can be required to explain the fraud. You may also need to put a temporary hold or a block on all future credit inquiries and credit cards purchases. This is done to prevent the fraudsters from damaging your finances any further.

What Should You Do if You Are a Victim of Medical Identity Theft?

After learning that your medical ID’s has been compromised, it’s key to act quickly. If you’ve enrolled in an identity theft protection program, contact that group immediately. They’ll help to reduce any further damage. Here are a few other suggested steps to take:

1. File a police report if necessary

Officially recording the medical fraud event with the local authorities can help to put the wheels of recovery into motion. Work with your identity theft recovery specialist to decide whether filing a police report is necessary.

2. File a claim with your identity theft protection team

Filing a claim is easy with American Family Insurance.

One of the best ways to report a claim is to log into My Account (Opens in a new tab) or use the MyAmFam app. And by initiating your medical identity theft protection claim with one of these options, you’ll also experience additional benefits including:

  • Filing anywhere, anytime
  • Tracking the status of your claim
  • Easily communicating with your claims representative by email or phone

You can always call us at 1-800-MYAMFAM (1-800-692-6326) to speak directly with a claims representative or contact your American Family Insurance agent (Opens in a new tab).

One of our representatives will review your case and put you in touch with a CyberScout fraud specialist who may reference the police report number in your file and will then take control of the case. They may place a hold or a freeze on your credit inquiries and inform debt collectors of the breach.

A passcode or PIN will be issued to you if you do need to apply for a loan. Be sure to keep that safe because it will be needed in the future to help prove your identity when interacting with these credit scoring agencies and lenders.

3. Contact those impacted by the fraud

Reach out to drug stores, your health insurance group and affected medical groups and other parties who’ve been defrauded — or, if you picked up coverage, let your fraud specialist do that legwork.

How to Protect Yourself from Medical Identity Theft

Like most things in life, preparation is often the best defense against the unexpected. In today’s high-tech world, data breaches continue to expose you to ID to fraud and abuse. Be sure to keep tabs on your credit rating, and carefully inspect explanation of benefits letters you receive. Here are a few other key ways to guard against medical fraud:

1. Purchase ID Theft Protection Coverage

When you pick up ID theft insurance from American Family, you’ll have monitoring in place — actively guarding your identity from thieves. Coverage like that can make a big difference because small problems are more likely to be detected early. And that can prevent an even bigger fraud event from ever occurring.

2. Don’t share your health insurance cards with others

Do your best to guard your medical ID, insurance cards and related data the same way you would your credit cards, loan applications and tax records. Sharing your health insurance card can be considered fraud, even if you mean well.

3. Access your free credit report

You are allowed one free credit report from each of the three major credit reporting bureaus annually: Equifax®, Experian®, and TransUnion®. These can be accessed via (Opens in a new tab) or by calling toll-free 1-877-322-8228 to order yours.

4. Keep tabs on your credit score

Other online credit monitoring products like Credit Karma and allow you to instantly get up-to-date credit score and FICO data every time you log in. Enrolling is free, it’s a great way to look carefully at your credit profile over time and you’ll receive free alerts when your credit score changes.

How to Prevent Medical Identity Theft

The best way to prevent medical ID theft is to monitor your credit rating and study medical bills carefully. And by outsourcing your credit monitoring, you’re more likely to get early warning — medical ID theft financial problems can escalate quickly. Want to learn more about identity theft protection? Make sure you are fully protected with great coverage. Learn how identity theft protection insurance from American Family Insurance can help. You’ll find more peace of mind with this important protection in place.

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