Medical ID theft leads to lengthy recovery

In a wallet full of credit cards, it was Jo-Ann Davis’ medical insurance card that became the golden ticket to stealing her identity.
Davis left her wallet atop her car on Christmas Day 2004, as she pulled away from a gas station on Route 60 in Robinson. When she realized she’d lost it, she cancelled her credit cards and made plans to get a new driver’s license, but didn’t think about her Highmark insurance card — that is, until a bill arrived in February 2005.

“I guess from what I tracked back in claim details, it started three days after I lost my wallet,” said Davis, 40, of Moon.

Carol Anne Hutchins, 30, of Bulger, Washington County, used Davis’ insurance to obtain pain medication and medical treatment almost 40 times before police caught her in May. Hutchins received about $16,000 worth of medical treatment at facilities from Altoona to East Liverpool, Ohio.

She served fewer than three months in jail and was sentenced to four years’ probation, according to Common Pleas Court records from Washington and Allegheny counties. Hutchins could not be reached for comment.

A Highmark privacy expert said Davis is the first known victim of medical identity theft in Western Pennsylvania. But it is likely that others are victims and don’t know it, experts said.

That’s because medical insurance companies might cover the entire cost of fraudulently obtained medical care, so the victim never gets a bill, said Kim Gray, chief privacy officer at Highmark.

“In (Davis’) case, we were fortunate. She was one of the smart consumers who read her statement of benefits,” Gray said.

Medical identity theft, a new wrinkle in identity theft, might affect as many as 250,000 people nationwide, according to the nonprofit World Privacy Forum, the only group to issue a report on the crime. The crime is more than an inconvenience — it can lead to potentially life-threatening mix-ups.

Every time an identity thief gets medical treatment or drugs in the victim’s name, the victim’s medical file is altered to reflect it, said Pam Dixon, executive director of the Cardiff, Calif.-based privacy forum. Once the file is altered, a doctor can’t simply delete the errors.

The false records can cause victims to fail background checks for insurance or employment, find themselves suddenly over their insurance coverage limit, get calls from collection agencies, have prescriptions altered because doctors think they have medical problems they don’t really have, or even have the wrong blood type listed for them, Dixon said.

Medical identity theft can ruin a person’s credit with thousands of dollars in medical bills.

Victims go through what can be an arduous process of appeals to correct their records, Dixon said.

Two medical identity theft cases have been prosecuted in Philadelphia.

Daniel Sullivan, 52, of Philadelphia, got $146,000 in medical care at four hospitals under someone else’s insurance. He was sentenced to up to six years in prison and ordered to pay back the money, according to the state Attorney General’s Office.

In the other case, Galen Baker, 50, of Philadelphia, pleaded guilty to using another man’s insurance to get 40 prescriptions of Viagra. Baker was sentenced to two years of probation and ordered to repay $3,000.

“It seems kind of funny, until you think what if (the victim) goes to the doctor for a heart problem and the doctor sees he’s on Viagra so he changes his heart medication,” said Barbara Petito, spokeswoman for Attorney General Tom Corbett.

Doctors and insurance companies are trying to determine how to prevent the crime. As a result of Davis’ ordeal, Highmark removed Social Security numbers from its insurance cards, Gray said.

There are holes left to plug, though, doctors said.

“It’s very easy to perpetrate this crime if you want to,” said Dr. Leslie Tar, an Allegheny County rheumatologist and attorney who specializes in elder law. “Doctors don’t have any obligation and typically don’t ask for any other type of identification (besides an insurance card). It’s not like you’re asked to show a driver’s license.”

The crime causes financial trouble that can be difficult to fix — one Colorado victim lost his business and has struggled for two years to get his life back together, according to the World Privacy Forum.

Fixing medical records can be even tougher. The Health Insurance Portability and Accountability Act of 1996 gave patients the right to see their files, but copies can be expensive and the process for correcting errors is murky, Tar said.

“There is no standardized way to go fix this. You can’t just handwrite over the records. It has to come in the form of an appeal,” Tar said. Also, “access to medical records is sometimes a problem. Maybe the doctor makes it available to visual inspection, but a copy is better if you need to go through it to look for errors. … The charge can be $1 a page. If you have a 30- or 100-page record, it can get expensive.

“It can be a nightmare,” Tar said.

Davis said she was on the phone with Highmark investigators every other day for four months, got hassled by bill collectors, came under investigation herself as police tried to see if she was in on the scheme, and had trouble getting her migraine medicine.

“I almost got arrested trying to get my own prescription filled,” Davis said. Shortly after Highmark began investigating the identity theft, Davis was picking up a prescription at the Robinson Giant Eagle. The clerk, seeing her insurance policy had been flagged, called police while Davis waited. They left after she explained the situation.

Considering how other forms of identity theft have flourished even with stricter security measures, Gray said she doubts any system can completely protect patients from medical identity theft. People need to pay close attention to benefit statements and other personal records to catch the crime early.

“There’s nothing we can do that is perfect,” Gray said. “These kinds of things are going to happen.”

Healthy advice

Privacy experts and doctors say the best way to protect against medical identity theft is to pay attention.

Check benefits statements. Insurance companies mail these documents to people they insure, listing medical procedures charged to a person’s policy. Make sure the statement reflects care that doctors say you received.

Check your medical file. The Health Insurance Portability and Accountability Act of 1996 gives patients the right to see their medical files. Patients also are entitled to a copy, though doctors can charge as much as $1 a page.

If your wallet is stolen, call your insurance company as well as your credit card companies.
If you are billed for a treatment you didn’t receive:

Call the doctor who billed you.

Call your insurance company.

Check your medical file to see if any other fraudulent procedures are under your name; if so, talk to your doctor about correcting the file.

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