Reviewed by Ian Lyngklip

Key Takeaways

  • Fixing the billing does not fix the chart; those are separate requests.
  • Providers have 60 days to grant or deny a record amendment.
  • A refusal must be in writing, and you can attach a statement of disagreement.
  • There is no $50 cap protecting you from fraudulent medical bills.

Medical identity theft is a serious and often overlooked form of identity theft that can have lasting consequences on your health, finances, and legal standing. Many Michigan residents are unaware that stolen personal information can be used to access medical care, alter health records, and create significant complications. Continue reading to discover how this crime can affect your medical records and consult with a Michigan identity theft lawyer today.

What Is Medical Identity Theft?

Medical identity theft occurs when a person uses your personal identifying information, such as your name, Social Security number, or insurance information, to obtain medical services, prescription drugs, or to make false claims for healthcare reimbursement. It is a specific type of fraud that targets health-related data and systems.

This crime is different from general financial identity theft because the consequences are not just monetary. Instead, they also directly impact your health and medical history. The offender essentially steps into your shoes to interact with doctors, hospitals, and pharmacies.

For example, an uninsured individual might use your name and health insurance card to receive treatment in an emergency room. Another common scenario involves someone using your identity to obtain expensive prescription medication for resale or personal use. While the immediate financial burden might fall on your insurer, there are long-term concerns when it comes to your medical files. The fraudulent use of your information creates a false trail in the healthcare system, linking you to services or conditions you never received or had.

Can Identity Theft Affect My Medical Records?

Yes, medical identity theft can significantly affect your medical records, misrepresenting a dangerous picture of your health. When an offender uses your information, the services you receive, such as diagnoses, treatments, lab results, and prescriptions, are all incorrectly logged under your name.

This fraudulent activity results in inaccurate health data being incorrectly mixed with your genuine medical history, and may remain unless properly corrected. Imagine a scenario where the thief receives treatment for a serious allergy or a chronic condition you don’t have. If you later seek treatment, a physician relying on your altered records might administer the wrong medication, which could lead to serious medical errors like harmful reactions, or overlook a real condition because the records indicate prior, irrelevant treatment.

Medical identity theft can also lead to denial of insurance claims if the thief maxes out your benefits or if the records show conflicting information. You might also find yourself being aggressively pursued by collection agencies for bills incurred by the impostor. Besides the financial and health risks, the process of correcting false records is often complex, time-consuming, and emotionally draining, requiring you to legally prove which parts of your medical history are false. Consult with a Michigan identity theft lawyer for help navigating this challenging process today.

What Are the Warning Signs?

Medical identity theft is often mistaken as a billing error, which is part of what makes these matters so damaging. As such, you should familiarize yourself with the signs below and treat them as fraud until your provider proves otherwise:

  • A bill or explanation of benefits for care you did not receive
  • Reaching your benefit limit earlier than you should
  • Receiving calls from providers or clinics you have never visited
  • Receiving collection notices for medical debt that you did not accumulate
  • A claim denial on the basis of a condition you do not have

Reporting the Fraud to Your Insurer

If you believe you are the victim of medical identity theft, the first thing you should do is call your insurance company, as they hold the claims record which will show what was billed and by whom. Before calling, you should gather your insurance card, the explanation of benefits statement, and copies of your medical records. When calling, you should specifically request the fraud department, rather than general customer service.

While the insurance company is investigating, you should anticipate a temporary freeze on your account. After the call, you should follow up with written statements that dispute each fraudulent charge and ask your insurance company to send a new member identification number, which will render the old one unusable. You should send this request via certified mail so you have proof that the insurance company received the request.

While you should not end up bearing the financial burden of care you did not receive or request, the matter can be complicated. Unlike the $50 cap on personal liability for fraudulent credit card charges, medical identity theft has no such mechanism. Clearing the bills is a process that often requires the assistance of an attorney, as there is no automatic protection.

Correcting Your Medical Records

Unfortunately, fixing the insurance aspect of this does not fix your medical chart. This means that your blood type may be incorrect, a diagnosis that is not yours may be included, or a medication you never take may be listed until you have these matters corrected. Unfortunately, this can impact the care you receive, so correcting these matters is integral to your health.

Under 45 CFR § 164.526, the HIPAA right to amend, you can ask a provider or health plan to correct information in your file. Put the request in writing, identify each entry that is wrong, say what the correction should be, and attach your identity theft documentation. The provider must act within 60 days, meaning it grants the amendment or issues a written denial. It may take one 30-day extension, but only with written notice before the first 60 days run.

If the Provider Refuses

In the event the provider refuses to remedy your records, they must do so in writing, complete wth an explanation of why. You then have the right to submit a statement of disagreement, which the provider must attach to the disputed information. Your statement will then travel with your records from that point. While this may not be your ideal outcome, it means that any physician who treats you and reads your chart will see your account of why you believe the information to be false.

When the Theft Starts With a Data Breach

Unfortunately, healthcare organizations, like medical offices, emergency rooms, and insurance companies, are often targeted because of the information contained in these medical files. A single healthcare record may contain an insurance number, a billing address, a date of birth, and even a Social Security number, in addition to your clinical history. This information can be more valuable than a card number, and providers are likely to pay a ransom to get this information back. Information that is not ransomed is often bundled and resold on the dark web.

If you receive a breach notice, place a fraud alert with one of the nationwide credit bureaus, which must refer it to the others. Then keep watching. A breach notice usually arrives well after the intrusion, so review your credit reports, bank statements, and explanation of benefits statements over the following months rather than assuming the alert closed the matter.

Connect With Our Consumer Defense Attorneys Today

At Lyngklip & Associates, we understand how complicated these matters can be to navigate on your own. That’s why our firm is committed to assisting you during this process to help you fight for the best possible outcome. When you are in need of legal guidance, do not hesitate to contact our firm today.