Medical Identity Theft: How This Type of ID Theft Occurs

Understanding Identity Theft

Identity theft involves the unauthorized acquisition and use of another person’s identifying information for fraudulent purposes. While many people are familiar with financial identity theft, medical identity theft presents a distinct challenge. It leverages sensitive health and personal data.

Understanding Medical Identity Theft

Medical identity theft occurs when an individual uses another person’s identifying information, such as their name, Social Security number, or health insurance details, to obtain medical goods or services, or to make false claims. Thieves typically seek patient names, dates of birth, Social Security numbers, health insurance policy numbers, and medical record numbers. Perpetrators also target sensitive health information, including diagnoses, treatment histories, and prescription details. This data can be used to receive medical care, obtain prescription drugs, or create new fraudulent identities.

Mechanisms of Medical Identity Theft

Medical identity theft can manifest through various pathways. One common mechanism involves large-scale data breaches within healthcare organizations. Hospitals, clinics, insurance companies, and third-party vendors can become targets for cybercriminals. When these systems are compromised, vast amounts of sensitive medical and personal information are exposed and sold online.

Another significant method is through social engineering tactics, which manipulate individuals into revealing their private information. Phishing emails, for instance, are designed to appear legitimate, often mimicking healthcare providers or insurance companies, and trick recipients into clicking malicious links or divulging credentials. Vishing, or phone scams, involves fraudsters posing as healthcare representatives to extract personal health details over the phone. Similarly, smishing uses deceptive text messages to achieve the same goal, often leading victims to fraudulent websites.

Physical theft also contributes to medical identity theft. Instances can include the theft of mail containing explanation of benefits (EOB) statements or other medical correspondence. Additionally, “dumpster diving” involves sifting through discarded medical documents that have not been properly shredded or disposed of, allowing thieves to recover sensitive patient data. The theft of personal devices, such as laptops or smartphones, that contain unencrypted medical information can also lead to exposure.

Insider threats represent a form of medical identity theft, as they originate from within the healthcare system itself. Employees or other individuals with authorized access to patient records may misuse their privileges to steal or sell sensitive information. This could involve direct access to electronic health records systems or physical files, leveraging their trusted position for illicit gain.

The misuse of medical information by family members or acquaintances also constitutes a form of medical identity theft. A person might use a relative’s insurance card or identifying details to receive medical treatment or prescriptions without the relative’s knowledge or consent.

Finally, compromised personal devices or unsecured networks can inadvertently lead to the exposure of medical information. If an individual’s personal computer, tablet, or smartphone is infected with malware, or if they access sensitive medical portals over an unsecure public Wi-Fi network, their data can be intercepted. These vulnerabilities can provide an entry point for criminals to access personal health information stored on devices or transmitted online.

Recognizing Medical Identity Theft

Identifying medical identity theft often involves noticing discrepancies in medical or financial records. A common sign is receiving bills for medical services or procedures that were never rendered or received. Similarly, an individual might start receiving collection notices for medical debts they do not recognize.

Another indicator is finding unexplained charges or services listed on an explanation of benefits (EOB) statement from an insurance provider. These statements detail the services billed to an insurer, and unfamiliar entries can signal unauthorized activity. Furthermore, an individual might be denied insurance coverage for a pre-existing condition they do not have, which could occur if a thief’s medical history becomes intertwined with their own records.