Soaring Medical Costs Give Rise to a New Kind of Identity Theft

[kurth]

ID Theft Infects Medical Records
Victims face bogus bills and risk injury or death. Privacy laws make such fraud hard to pursue.
By Joseph Menn, Times Staff Writer
September 25, 2006

After shoulder surgery last year, Lind Weaver was stunned when hospital bill collectors demanded that she pay for the amputation of her right foot. "Either you didn't do the surgery, or you did a really job of it," Weaver told them, sending along notarized photos of her toes, all still attached. "Either way, I'm not paying." But the 56-year-old retired schoolteacher quickly discovered she was dealing with something more nefarious than a simple clerical error: An identity thief had obtained medical care under Weaver's name and had the bill sent to her insurer.

A year later, Weaver is still trying to catch errors in her medical records and clear the hospital bills fraudulently run up in her name. "It became a 40-hour-a-week job," Weaver said. "I put my phone to my ear and sat there listening to elevator music." Although the most typical of the millions of identity theft cases in the U.S. each year involve credit cards, a 2003 federal report estimated that at least 200,000 instances involved medical identity fraud. Experts believe that the rising cost of healthcare is driving more identity theft, and that many people are unaware they have become victims unless they receive a hospital bill or query from their insurer.

"There's no reason to assume the patients ever find out," said Harvard University management professor Malcolm Sparrow, an expert on regulatory agencies who has written books on healthcare fraud. "The bulk presumably remain invisible." With their medical records compromised, victims of this kind of fraud face a greater risk of injury or even death if doctors make treatment decisions based on bad information. Files might list incorrect prescriptions or the wrong blood type. Or, as in Weaver's case, an erroneous diagnosis of diabetes. Bad information can also put careers and insurance at risk. Many employers, including more than a third of the Fortune 500 companies, demand access to medical records when making hiring, promotion or benefits decisions, according to the nonprofit Patient Privacy Rights Foundation. Health and life insurance companies routinely scan medical files or payout reports before issuing new policies.

Victims, though, often find that clearing their medical records of bad information is much more difficult than fixing credit reports, which are centralized in three major credit bureaus. Consumers have the right to obtain one free credit report annually, and to demand an investigation of information they believe is fraudulent or incorrect. Unverified reports must be removed promptly. Medical records, in contrast, can be scattered across dozens of doctors' offices, hospitals and clinics. And federal privacy rules intended to protect private information can make it difficult for patients to even obtain their own records when identity theft is suspected. "These privacy rules might put you in a situation where you can't even investigate," said Wilma Kidd, chief privacy officer at WellPoint Inc., the largest U.S. health insurer for employees and other groups...

http://www.latimes.com/business/la-fi-medid25sep25,0,5686619.story?coll=la-home-headlines

[serryjw]

1. I would counter sue

The doctors and hospitals have to be partially responsible. It is impossible that all the medical information compared exactly with the impostor.There has to be referrals medical history. MOst insurance companies require approval before any surgery....someone/somewhere should have asked a question.......??? You would think?

[TexasLawyer]

2. yet more proof that the US health care system

is messed up. This kind of fraud would be greatly minimized under a single-payer system.