Provider Medical Identity Theft

Identity theft is a common fear and a common problem.  Readers of this blog know that identity theft is a problem that reaches beyond the financial sphere.  Quite often, health care fraud cases involve an element of medical identity theft.  In a previous post, our medical identity theft lawyer discussed the problem of scammers stealing consumers’ medical identities and using the information to submit and collect on false claims.  However, consumers are not the only targets of medical identity theft.  Provider identity theft is also a component of many health care fraud scams, criminal enterprises that divert critically needed health care dollars and endanger the health and well-being of countless Americans.

Clinic Owner Allegedly Filed Claims Using Former Owner’s Provider Information

In late August 2012, NBC New York reported on the arrest of a man who operated a radiology practice in Queens on charges that he engaged in health care fraud.  According to the article, a 34 year-old man by the name of Ting Huan Tai was taken into custody by federal agents who arrested him at his luxury apartment in a Lower Manhattan high-prescriptionrise.  In May 2010, as alleged in court filings, Tai took over operations at United Medical Diagnosis (“UMD”), a radiology clinic in Flushing, New York.  From May 2010 through May 2012, Tai and his staff allegedly used the identity of the clinic’s prior owner, a radiologist, to submit more than $30 million in claims to Medicare and Medicaid.  The claimed services were not actually performed and the bills were submitted without the knowledge or consent of the former UMD owner.  United States Attorney Loretta Lynch explained, “The defendant sought to enrich himself and fund his lifestyle first by stealing a doctor’s identity and then using that stolen identity to steal Medicare and Medicaid funds…While the documentation provided was a sham, the money stolen was very real.”

Two Main Types of Fraud Involving Provider Identifier Information

A Provider Education pamphlet authored by the Centers for Medicare and Medicaid Services (“CMS”) notes that there were more than 3,600 reported cases of physician and patient medical identity theft in 2009 and more than 12,000 reported cases between 2007 and 2009.  CMS suggests that there are two main ways scammers use stolen provider identification information to file fraudulent claims.  The first involves using provider identification to create the appearance that the provider ordered/referred patients for services like diagnostic testing, home-based care, or durable medical equipment.  The second approach uses the misappropriated physician identifiers to make it look like that medical professional provided and billed for services directly.  In both cases, the physician does not consent to the use of his/her identity and often doesn’t even know the perpetrator.

Preventing Theft and Misuse of Physician Medical Identifiers

CMS further suggests that providers take active steps to protect their medical identifiers.  Four strategies suggested by the agency involve: 1) Actively managing enrollment information, including notifying payors of significant changes like closing a practice so they can alert the provider to suspicious claims (ex. billings from a closed practice); 2) Implementing and overseeing billing and compliance processes, a strategy focused on maintaining responsibility for billings in the provider’s name; 3) Avoiding sharing unique medical identifiers; and 4) Engaging patients by raising awareness about medical identity theft and explaining the importance of reviewing medical bills/explanation-of-benefits (“EOB”) forms.

Combatting Fraud: Working with Our Medicare Fraud Team to Catch Scammers and Recover Funds

Whether you are a provider, medical staff, or a medical consumer/patient, you can play a role in combatting medical fraud.  Call our medical fraud law firm at (800) 427-7020 if you believe you have witnessed medical identity theft or any other form of health care fraud.

See Related Blog Posts:

The Dangers of Medical Identity Theft

Beneficiary-Reported Medicare Fraud

(Image by Kathea Pinto)