Why you care about insurance fraud

Your medical records could be targeted by a fraudster; learn how to protect yourself

Every time I go to the dentist, the receptionist panics. Then she asks for my birthday and address and scans my file carefully. It seems that this dentist office has another patient with my name. So what's my gripe? Even with the red flag the office has on my chart, the receptionist has never asked to see my identification. She has never asked me to confirm when I last received treatment. And the office has yet to attach a photo to my chart so that she can see at a glance if she has the right person.

My dentist's office realizes that it would be bad (thus, the panic) if they mixed my chart up with someone else's. But they assume that I am who I say I am and that I'm trying to help clear up the confusion. It has not occurred to them that someone might pose as me to get treatment they can't afford. The fact is, though, medical ID theft -- where someone poses as someone else in order to make an insurance claim -- is a huge problem. The World Privacy Forum estimated in 2006 that 250,000 to 500,000 people were victims of medical identity theft. That's an old number and probably an underestimate because it's hard to get accurate numbers on fraud. But according to James Quiggle, spokesperson for the Coalition against Insurance Fraud, "Medical ID theft is the fastest growing form of identity theft in America today. It is taking off like wildfire and posing a serious health threat to consumers."

Stemming the problem
Yesterday the FTC held a Town Hall Meeting in Washington, D.C., to discuss this epidemic problem. And in June, the Coalition Against Insurance Fraud, the National Health Care Anti-Fraud Association, and the National Insurance Crime Bureau -- with participation from the FBI and Department of Justice -- announced a joint project called the Consortium to Combat Medical Fraud. Its agenda is to aggressively pursue the perpetrators of medical fraud.

So why should you care if insurers are being defrauded?
If someone poses as me to get access to my medical care, they not only cost my insurer money, they pose a health risk for me -- with untold repercussions. If the poser uses my insurance to have a baby or have her appendix removed, she alters my medical records. Now my medical history says that I have a baby that I don't have or that I don't have an appendix I do have. If I go to the hospital with a ruptured appendix, I'm very likely to be misdiagnosed. The baby? Check out this video to see how badly that can turn out: