One Sick Scam

One Sick Scam

It’s well established that average Americans find it difficult to save money. Come to think of it, there’s good reason for this. In a stagnant wage environment, they face high and ever increasing costs from legitimate sources, everything from supermarkets, gas stations and drug stores to car repair shops, banks, clinics, the folks who collect college tuition, room and board, and the taxing bodies of local, state and federal governments.

When they’re done paying through the nose for all the expenses of daily living, and counting whatever may be left for enjoyment, consumers must fend offscam artists looking for an opportunity to separate targets from hard-earned savings. In short, consumers fall victim to what in many cases is figurative highway robbery from legal enterprises, then must gird their loins to protect against real robbery from illegal entities.

Anything in the news is fertile ground for construction of a scam or fraud. Keep that in mind as we move toward January 1, 2014, the day the Affordable Care Act, better known as healthcare reform, goes into effect. The closer we come to that date, the more likely you’ll see fraudsters using confusion to line their pockets with greenbacks.

I recently wrote a series of articles about healthcare reform, and interviewed a number of high-ranking government officials about the provisions of reform and what it will mean to people in various neighborhoods in my hometown of Chicago. I can tell you there is great uncertainty among the people best-versed in healthcare reform about its manifestation in 2014 and beyond, and how it will be instituted. If people actually tasked with helping implement reform are confused, you can imagine how clueless the rest of us will likely be.

That confusion should provide just the right Petri dish for the incubation of scams and frauds that will grow, blossom, and multiply as they leave people far and wide sick at heart.

The end goal of many of these nefarious acts is medical identity theft. Regular identity theft is the theft of personal information to enable commission of crimes. Medical identity theft is the theft of medical identification, such as insurance cards or Medicare numbers, to commit acts of healthcare fraud. That identification is then used to defraud insurance firms, Medicare, or Medicaid. Money that should be available to pay legitimate claims is instead being raked in to swell the coffers of the perpetrators of medical identity theft.

While much of the concern is about frauds committed against companies or the government, you can also face very real harm from medical identity theft. The obvious concern is that we all pay higher premiums when people defraud insurance companies, and that it’s essentially our tax dollars at risk when Medicare or Medicaid fraud occurs.

But medical identity theft can result in you not getting the healthcare you need if someone uses your identity to gain health care services in your place. It can also mess with your medical records, which can threaten your well-being if inaccurate medical records result in you not being able to access the right services, or being denied care.

What form does medical identity theft take? Let us count the ways. It can be done overtly, such as by stealing your purse or wallet. But the more insidious are the frauds that look authentic and are designed to tempt average folks with too-good-to-miss offers.

In one of the most diabolical, fraudsters use the premise of healthcare reform to induce potential victims to accept what the swindlers claim are free services. The claim is that the free services, whether they be free blood pressure tests, free use of equipment, or free consultations, are suddenly available to them because of the passage of reform.

It’s simply a ruse to get the victim to divulge his or her insurance or Medicare ID numbers, which can then be used to bill for services never rendered.

Another scheme involves flim-flam artists masquerading as government officials or insurance reps to learn victims’ medical ID numbers. In still another, fraudsters claim to be conducting important health surveys that require participants to provide identification.

Once state-operated health insurance exchanges are up and running after January 1, 2014, look for con artists to emerge from the woodwork with claims their insurance offers are from the exchanges, when in fact they have nothing to do with the exchanges. They’ll count on initial confusion about health reform’s provisions to peddle unauthorized insurance plans.

What can you do? Guard your insurance card as vigilantly as you would your credit cards, give out your medical identification numbers only to legitimate providers, don’t provide medical ID numbers in exchange for offers of free services, and shred your medical documents before disposing of them.

If your insurance card is stolen, contact your insurance company. If your Medicare card is swiped, call Medicare at 800-MEDICARE. Call the Federal Trade Commission’s Identity Theft Hotline at 877-ID-THEFT. Also call the Health and Human Services Office of Inspector General’s Fraud Hotline to file a fraud report at 800-HHS-TIPS.

With a bit of healthy vigilance, we can reduce medical ID theft’s ill-gotten gains.

One Response to “One Sick Scam”

  1. Anonymous

    Another kind of healthcare fraud might be someone else using your medical insurance to obtain care. My health insurance is with a large health maintenance organization. I don’t always see the same doctor as I can choose from several if my assigned primary physician is not available. Several years ago, they started to ask me (and all other patients) to provide a photo ID and well as my insurance card when I visited the doctor. That made me think that uninsured family and friends might have been using the HMO services by borrowing the insured’s HMO card.

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