Medical Identity Theft: A Growing Threat to Seniors and Their Healthcare Security

As the senior population becomes increasingly vulnerable to financial exploitation, medical identity theft is emerging as a significant concern. According to the FBI's 2023 Internet Crime Report, individuals aged 60 and older lost an alarming $3.4 billion to identity theft in 2023—far more than any other age group.

While traditional identity theft is widely recognized, medical ID theft is on the rise, particularly among older adults, posing serious threats to their finances and health. Yet, awareness of this issue remains low.

"While medical identity theft is not as commonly discussed as other forms of identity theft, the consequences can be just as devastating," said Eva Velasquez, the Identity Theft Resource Center's CEO and president.

The repercussions can be far-reaching, including denials of medical coverage and receiving bill for procedures never performed.

What is Medical Identity Theft?

Medical identity theft occurs when someone fraudulently uses another person's personal information—such as a name, Social Security number, or health insurance details—to obtain medical services or goods, file false insurance claims, or gain access to prescription medications.

Medical identity theft is especially harmful because it can remain unnoticed for years. Victims often only become aware of the theft when they receive a bill for services they never used or when their insurance claims are rejected due to exhausted benefits.

The consequences for victims can be devastating. Financial losses are just the beginning. Victims may discover their medical records have been altered, leading to potentially dangerous treatments or medications being prescribed based on incorrect health information. Moreover, they could face denied coverage or inflated insurance premiums. In severe cases, the theft of prescription drugs under a victim's identity can trigger a criminal investigation.

Seniors at Higher Risk

Older adults are particularly vulnerable to medical identity theft due to several factors. A trusting nature, limited tech-savvy, and growing up in a time when such sophisticated scams didn't exist make them prime targets. Many seniors have accumulated significant savings, making them especially attractive to scammers.

Compounding this issue is that most seniors don't recognize the signs of medical fraud until it's too late—usually when they receive unexpected bills, calls from debt collectors, or notifications that their insurance policy has reached its limit. By then, the damage is often done.

Higher Risk - Those in Long-Term Care

Medical identity theft poses a unique threat to individuals in long-term care, as they are often more vulnerable due to their reliance on caregivers, compromised health, and sometimes diminished cognitive abilities.

Those in long-term care facilities may not regularly review their financial or medical records, making it easier for identity thieves to exploit their personal information for fraudulent activities. Their adult children may not be paying attention, unaware of the problem of medical identity theft and dealing with the other issues related to a loved one needing extended care.

In many cases, seniors in these long-term care facilities depend on others to manage their finances and healthcare, adding an additional risk if caregivers or facility staff misuse or mishandle sensitive information.

For those living in long-term care facilities, the consequences of medical identity theft can be especially severe. Just like anyone else, if a thief uses their identity to obtain medical services, it can result in inaccuracies in the victim's medical records. However, for older adults with multiple health issues, this can lead to dangerous consequences, such as incorrect diagnoses, improper medications, or inappropriate treatments.

In a setting where timely and accurate medical care is critical, such errors could have serious, even life-threatening, effects. Additionally, seniors in long-term care who fall victim to this type of fraud might face denied insurance claims, leaving them or their families with significant out-of-pocket expenses.

Furthermore, those in long-term care facilities may not have the same oversight or advocacy as individuals living independently, which can delay fraud detection. Individuals living in Medicaid facilities, for example, who often have limited staff, are especially vulnerable. However, the problem is not limited there.

Quality long-term care facilities can limit the risk, but it does not eliminate the risk. If a loved one needs long-term care services, use the LTC News Caregiver Directory to narrow down options, and be sure to ask about the security of medical records.

Facilities should implement strict safeguards, including regular reviews of medical billing and insurance records, to prevent and detect medical identity theft. Family members or legal representatives should also remain vigilant by periodically reviewing financial and medical statements for their loved ones to catch any unusual activity early.

The Costly Consequences of Medical ID Theft

For older adults, falling victim to medical identity theft can be life-altering. Imagine a situation where a scammer receives medical treatment under a senior's name, leading to incorrect information in the victim's medical records. This could cause their healthcare provider to prescribe dangerous treatments or medications based on fraudulent data.

Beyond personal health risks, the financial repercussions are significant. Many victims are left paying for healthcare services out-of-pocket after the fraudster maxes out their Medicare, private insurance policy, and even Long-Term Care Insurance benefits. Furthermore, medical debt incurred under their identity can affect credit scores and financial stability.

Protecting Seniors from Medical Identity Theft

So, how can you help seniors protect themselves from becoming victims of medical identity theft? Below are some practical steps that can make all the difference.

1. Be Skeptical of Unsolicited Communications

Shady actors often pose as Medicare agents, insurance providers, or healthcare professionals to gain access to sensitive information. Seniors should be cautious of unsolicited phone calls, emails, or messages, even if they appear to come from familiar sources.

Scam telemarketing calls about Medicare are becoming increasingly common. If you receive a call about Medicare benefits, always ask the caller for their National Producer Number (NPN), which all licensed insurance agents are required to have and provide. Many fraudulent callers operate from overseas call centers, and a strong accent combined with evasive or vague answers can be a warning sign of a scam. Stay cautious, and don't hesitate to hang up if something doesn't seem right.

·       Medicare Scam Calls: Types of Scams and Protecting Your Identity

If something feels suspicious, hang up and contact the organization directly using a verified phone number. It's important not to act impulsively or provide any personal information during unsolicited interactions. Always verify before sharing.

2. Safeguard Personal Information

Protecting personal information is key to preventing medical identity theft. Seniors should never share their Social Security number, health insurance details, or other personally identifiable information (PII) unless absolutely necessary and verified as legitimate.

It's also crucial to keep printed medical documents, insurance claims, and prescription records secure. Sensitive information should be stored in a locked location, and old documents should be shredded rather than simply discarded.

3. Monitor Financial and Medical Transactions

Keeping a close eye on medical and financial records can help detect identity theft early. Seniors should regularly review their bank statements, credit reports, and insurance Explanation of Benefits (EOB) statements. These documents can reveal unauthorized transactions or unfamiliar medical claims.

Comparing medical appointments, treatments, and insurance claims against the records from the insurance provider can also help spot any discrepancies.

4. Report Suspicious Activity Promptly

If there's any indication of fraud—whether it's an unfamiliar medical claim or a suspicious phone call—it's important to report the incident immediately to the relevant organization. Doing so can trigger an investigation and help mitigate further losses.

Victims of medical identity theft should also report the crime to law enforcement and the Federal Trade Commission (FTC). The FTC offers resources to help individuals recover from identity theft, including personalized recovery plans.

• Medical Identity Theft – What to Know, What to Do (ftc.gov)
• Preventing Provider Medical Identity Theft Fact Sheet (cms.gov)

Why Awareness Matters

Medical identity theft is not only about financial loss; it directly impacts the health and well-being of seniors. In an era when healthcare costs are skyrocketing, this kind of theft is a threat that cannot be ignored.

Unfortunately, the lack of awareness surrounding medical identity theft, coupled with the complex and often hidden nature of the crime, leaves seniors particularly vulnerable. By adopting a cautious mindset, securing personal data, and keeping track of medical and financial records, seniors and their loved ones can protect themselves from falling prey to this growing threat.

Final Thoughts

As healthcare needs rise with age, seniors cannot afford to take medical identity theft lightly. While they are often seen as easy targets due to their trusting nature and accumulated savings, there are concrete steps they can take to protect themselves. Regularly monitoring accounts, maintaining a healthy dose of skepticism, and immediately reporting any suspicious activity can make all the difference in safeguarding their healthcare security.

Awareness and proactive steps are the best defense against this growing threat.