Why you care about insurance fraud

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

But this form of ID theft is just the tip of the iceberg. "The big money is not in the free treatment scam," says Quiggle. "But rather in the large-scale theft of patient lists by medical insiders. A low-paid data-entry clerk with too much access to patient databases can make a lot of money -- as much as $50 per name -- stealing names and selling them to criminals." These are usually paper crimes where no one got any actual treatment. The insurance companies are billed in large quantities for the same treatment. But even though no treatment was performed, this muddies your medical records. "We are not talking about scams of overpriced cotton balls," says Quiggle. "These are surgeries you never had."

The weak link
The small medical practice is one of the weak points in the system. Like my dentist, these offices are run by medical professionals, not necessarily experts at data security or management. That they often don't ask for an ID or take other obvious measures against ID fraud is one thing to worry about. (And some practices are starting to correct this.) But how much do they know about that clerk they hired to catch up on their backlog of insurance paperwork and data entry?

There is little -- beyond sharing my knowledge when I visit my practitioners -- that I can do to prevent my name from being stolen by a clerk at my doctor's office, but there is a lot I -- and you -- can do if my name does end up in one of these fraudster's hands. There are lots of details on this at the World Privacy Forum.

But for starters, here is a quick list of things you can do to keep an eye on your medical ID:

• Closely monitor any "Explanation of Benefits" your health insurer sends. Make sure you received all the treatments they are paying for. If you see any discrepancies, call your insurer and your medical practitioner immediately and file a police report.
• Ask your health care providers for a copy of your file so you can check that you received all the treatments on record. Or, since many don't like to give those out, simply ask when you were last in and what treatment you received every time you go to a practice.
• Keep an eye on your credit report.

• Share your knowledge of this threat with the medical practices you visit and suggest that they add a photo to your database or ask patients for identification. This isn't a perfect solution. But my pharmacists started doing this recently and told me that several times a week someone claims they left their ID in the car. And never returns.
• If your insurance is used in a false claim, write to your insurer and detail what's wrong about your records. Under HIPAA, it can be very difficult for you to make changes to your medical records. "But you can at least have your side of the story added to the records," advises Quiggle. "At least then doctors are on notice and they will be on high alert that there may be inaccuracies in your file."