This topic has been attracting increasing comment in the US recently.
First we have a review from iHealthBeat.
Scope, Future of Medical Identity Theft Examined
by George Lauer, iHealthBeat Features Editor
Pervasive, profound changes in health IT promise all kinds of new possibilities for all kinds of people -- patients, clinicians, policymakers, insurers … and criminals.
Stealing and cashing in on medical identities is the "theft of the future," according to Kirk Ogrosky, deputy chief for health care fraud in the Department of Justice's criminal division.
"If they do it intelligently, they're probably not going to be detected," Ogrosky said, adding, "We have to figure out how to use technology to at least keep up with criminals and maybe even get ahead."
Ogrosky was one of more than a dozen panelists at a day-long town hall meeting on medical identity theft last week hosted by HHS' Office of the National Coordinator for Health IT. More than 500 signed up to participate in the meeting either in person or online -- a measure of the health care industry's attempt to get its arms around a potentially significant but so far largely unknown problem.
"This is an emerging issue. We really are in the awareness phase," said Jodi Daniel, ONC's director of policy and research. "We hope meetings and dialogue like this will help us get out in front of what could become a huge issue," she said.
Two Kinds of Theft
Most medical identity theft falls into one of two broad categories:
- "One-off" crimes in which an individual's medical identity, including health insurance, is co-opted by another individual with or without consent; and
- Systemic theft in which medical identities are stolen in large numbers and used to bill for services never delivered.
Both types of theft were represented at the town hall meeting.
Nicole Robinson of Maryland learned in 2000 that a woman in Texas had stolen her identity and run up numerous medical and dental bills. The Texas woman was arrested, but the issue is not resolved. Now, eight years later, the real Nicole Robinson still is not sure what is and isn't accurate in her medical records.
"Because of privacy rules governing health care, I can't actually look at and clear my own records," Robinson said.
Harry Rhodes, director of practice leadership for the American Health Information Management Association, said accuracy in patient records should be paramount.
"The value of data integrity far outweighs any other issue," Rhodes said, adding, "It's certainly of greater value than locking up the record tight and not letting the patient see it."
Marcy Wilder, a lawyer who specializes in health information law at Washington, D.C., law firm Hogan & Hartson, said there simply aren't good solutions for victims of medical identity theft.
"There are very clear-cut steps you can take to protect your financial identity, but there are not clear steps yet to protect your medical identity. In the future as health IT is more widely adopted and gets better, that may change. But right now, there just aren't any good answers," Wilder said.
Ogrosky gave sobering examples of systemic fraud, most dealing with Medicare billing.
"In Dade County -- the Miami area -- Medicare identities are worth about $25 to $50 a name," Ogrosky said. He told a tale of a woman working in a cardiac clinic who stole hundreds of Medicare identities using a thumb drive. She sold the data to others who set up a phony clinic fitting non-existent patients with expensive prosthetic limbs and orthotics.
"They billed Medicare for about $400 million, and CMS paid about $100 million," Ogrosky said.
Lots more (including links) here:
http://www.ihealthbeat.org/Features/2008/Scope-Future-of-Medical-Identity-Theft-Examined.aspx
And we have more here:
ONC tackles medical identity theft
By Diana Manos, Senior Editor 10/17/08
Leaders and stakeholders gathered this week to discuss medical identity theft and how the federal government could lead a campaign to prevent it.
In a town hall meeting sponsored by the Department of Health and Human Services' Office of the National Coordinator for Health IT (ONC), experts explained how statistics are scarce on the extent of the problem –in part because most often the crime is committed by company insiders and goes unreported.
Others explained how medical identity theft can have devastating effects on victims.
According to Linda Foley, founder of Identity Theft Resource Center, victims of medical identity theft want a clean record, but there aren't many answers for how to help them. Sometimes the thief mixes their information with another patient's, making the clean-up particularly difficult.
Some doctors have begun taking photos to include in patient records, Foley said.
Pam Dixon, executive director of the World Privacy Forum, said the loss to a patient from a single incident of medical identity theft can range from $2,000 to $250,000.
Dixon urged any federal campaigns to prevent medical theft to include input from victims who understand the complexities of the damage and what it takes to help victims through the process.
Gary Cantrell, from the HHS Office of the Inspector General, said victims can pay $800 to $5,000 out-of-pocket on bills racked up via medical identity theft to prevent further damage to their credit ratings. They report the crime to several agencies, but wonder if the case has been dropped through the cracks.
"We need to help the consumer and have a plan of action to reassure them that something is being done," Cantrell said.
More here:
http://www.healthcareitnews.com/story.cms?id=10216
It seems to me that while this is likely to be less of a problem here than in the USA – mainly because we have so many less funders of care and because Medicare Australia is involved in so many transactions – that getting away with this sort of fraud would be a good deal trickier than in the US and probably not as profitable.
That said it is important to be alert to the possibility and to make sure any systems that are put in place make it has hard as possible for such fraud to occur.
David.
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