Key takeaways:
Identity theft is when someone pretends to be you in order to buy goods and services — that eventually get billed to you. One version of this is Medicare identity theft.
If a scammer gets access to your Medicare ID number, they can receive healthcare services under your name. You can reduce your risk of Medicare identity theft by keeping your Medicare card and documents private.
You should also review your Medicare summary notices to make sure all of the claims listed are for services you’ve received. If you suspect fraud, report it immediately.
Healthcare-related fraud is on the rise. According to the FBI, the number of victims of healthcare-related fraud more than doubled from 2019 to 2020, a period that saw reported losses soar from $1.1 million to $29 million. And the majority of victims were over 60.
One common kind of healthcare-related fraud is Medicare identity theft, which happens when a thief uses your personal information — including your Medicare ID number — to access your healthcare benefits. This could include using your insurance to:
Fill prescriptions
Purchase medical equipment
Receive medical treatment
Submit fraudulent claims
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The more you understand about Medicare identity theft, the easier it is to reduce your risk of becoming a victim. Your best defense is to:
Learn the ways someone could steal your identity
Stay aware of the warning signs
Safeguard your personal information
And if you do become a victim of identity theft, knowing how to respond appropriately can limit the damage.
Medicare identity theft can do more harm than you might think. Below, we detail four ways that this type of fraud can injure you in the long term.
One big danger of Medicare identity theft is that it could make your medical record inaccurate. Your record might list the identity thief's medical conditions and treatment history, mixed in with your own. And if you don’t know that your identity has been stolen, you may not be aware that this incorrect information is included, but it could inform the care you get. This is one reason why healthcare providers ask you to review your medical history before office visits.
Whenever someone files a claim using your Medicare number, the activity is added to your claims history. An identity thief’s claim activity could use up your Medicare benefits. This could cause a delay in or denial of coverage for treatments or medications.
And if you have Medicare supplement insurance (Medigap), your insurer may interpret an identity thief’s preexisting condition as your own, leading to a denial of coverage.
Surprise bills are common when someone else is using your Medicare number. You could get stuck with charges for copays and expenses that aren’t covered by your plan. And if you’re not paying attention, you might go ahead and pay these bills, reducing your cash on hand.
Medical debt can drag your credit score down, affecting your ability to get a credit card or mortgage. Adding insult to injury, getting your credit record corrected is time-consuming and often costly.
Luckily, there have been recent changes to the credit-reporting process that impact people with medical debt. As of July 1, 2022, the top consumer credit-reporting agencies — Equifax, Experian, and TransUnion — don’t add unpaid medical debt to your credit report until after 1 year. And in 2023, these agencies stopped adding medical debt of less than $500 to your report. Though, amounts over $500 may still impact your credit score.
Yes, an identity thief can commit fraud with just your Medicare number. So it’s important to protect your Medicare card like you would a credit card.
A few years ago, the Centers for Medicare & Medicaid (CMS) made some changes to Medicare cards to protect beneficiaries from fraud. Between April 2018 and January 2019, the agency sent enrollees new Medicare numbers and cards that didn’t include their Social Security numbers. But it’s still important to be careful, because scammers can use your new Medicare number to commit healthcare fraud.
Scammers use a range of tactics to try to get access to your health insurance information. Here are the top reasons Medicare identity theft occurs.
Hackers can invade databases to steal hundreds of Medicare numbers at one time. Data from the U.S. Department of Health and Human Services (HHS) indicates that security breaches affecting protected health information (PHI) increased 25% during the pandemic.
Identity thieves often use impersonation to try and trick you into sharing personal information. They do this by pretending to be:
Government employees
Healthcare providers
Insurance representatives
An identity thief impersonating one of these figures may contact you through:
Phone calls
Letters
Emails
Text messages
Government figures show that identity theft and imposter scans were the most reported frauds of 2021. And phishing — impersonation via email or text — was the top form of internet-based fraud from 2019 to 2022, according to the FBI.
Unfortunately, in some cases, people who work in healthcare commit fraud. In 2021, the U.S. Department of Justice (DOJ) charged 138 workers with alleged involvement in fraud schemes that amounted to $1.4 billion in losses. Among the accused were 42 doctors, nurses, and other licensed medical professionals.
When someone steals your Medicare number, they can use it to access healthcare services, file fraudulent claims, and more. The upside is that these activities create a trail for you and investigators to follow.
Here are four signs that you may be a Medicare identity theft victim.
If you get contacted by a provider or debt collector about healthcare services you didn’t receive, ask for specific details about the services, including the dates and provider names, and then check them against your own records. If you suspect fraud, contact the healthcare provider that’s listed on the fraudulent claim, Medicare, and any other insurer you have coverage through to let them know.
If your insurer contacts you to let you know that you’ve met your benefits limit and you believe this is incorrect, request a list of the services in question and report any that you did not receive.
If you’re denied coverage because of a preexisting condition that you don’t have, ask the insurer for specifics and work with them to correct your record.
Review your receipts, Medicare summary notices, and other healthcare statements to spot suspicious activity early on. Note your medical appointments, tests, and prescription refills on a calendar, and use that information to reconcile your statements. And report any mistakes that you notice immediately.
Many credit card companies and all credit-reporting agencies provide fraud alerts for account holders. These alerts will notify you of suspicious activity as soon as it’s detected — often within moments, and well before your next statement. Your property insurer may also offer additional coverage that includes identity theft monitoring. Consider signing up for these added layers of security.
If you suspect your identity has been stolen, contact Medicare immediately:
Medicare Part A and Part B beneficiaries: Call 1-800-633-4227 (1-800-MEDICARE) or 1-877-486-2048
Medicare Part C (Medicare Advantage) plan members: Contact your specific plan to report fraud.
For general reporting information: Contact the HHS Office of the Inspector General’s hotline.
The Medicare website lists the information you’ll need to have on hand when you report the fraud.
After you’ve contacted Medicare, reach out to other organizations who can help you restore your identity and credit, such as:
Federal Trade Commission (FTC): You can contact the FTC via identitytheft.gov or by calling 1-877-438-4338. The agency will provide you with a recovery plan to help you move forward.
Internet Crime Complaint Center: You can report the fraud to the FBI's Internet Crime Complaint Center, if the identity theft occurred online.
At present, there’s no law limiting the damages that can be incurred by victims of medical identity theft. But many property insurers now offer identity theft protection. Some common features of protection packages are:
Advanced fraud monitoring
Fraud notification
Identity-recovery services
Coverage that reimburses certain theft-related costs
Identity theft protection companies — which specialize in reducing the risk and impact of identity theft crimes — provide similar coverage and services. Though this type of coverage comes with a cost, it may make sense for you, depending on your current financial situation and risk profile. You can consult with your banker or insurance agent free of charge to better understand your risks and coverage options.
Keeping your identity safe isn’t overly complicated. Follow these best practices to reduce your risk of Medicare identity theft:
Keep your Medicare number private. Avoid reading your Medicare number out loud in public places. Don’t give your Medicare card or number to anyone except your healthcare provider. Refuse any offers of money or gifts in exchange for your Medicare number.
Treat your Medicare card like it’s a credit card. Don’t keep your Medicare card out where others can see it. Like your credit card, your Medicare card carries sensitive information, so make sure it’s stored in a safe place.
Safeguard insurance and other healthcare-related documents. Instead of just throwing them in the trash, file or shred paperwork that includes your Medicare and Social Security numbers. Use a marker to black out information on materials that are hard to shred. And remove newly delivered mail from your mailbox as soon as possible to reduce access to your personal information.
Get digital access. Sign up for official email updates from Medicare and any other insurer you have coverage with. Take advantage of online platforms to access new information about your healthcare claims and billing. Smartphone apps, in particular, make it easier to track and verify account changes and claims activity from your mobile device.
With a few new habits, you can reduce your risk of becoming a Medicare identity theft victim. To start, be careful about sharing your data, and actively question charges and claims that aren’t familiar. These actions aren’t rude or insulting; they’re smart. Reputable healthcare providers, insurers, and Medicare representatives will understand and appreciate your concern.
Centers for Medicare and Medicaid Services. (2019). CMS finalizes New Medicare Card distribution ahead of deadline, accelerating fight against Medicare fraud and abuse.
Consumer.gov. (n.d.). Recovering from identity theft.
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Federal Bureau of Investigation, International Crime Complaint Center. (2021). 2020 internet crime report.
Federal Bureau of Investigation, International Crime Complaint Center. (2023). 2022 internet crime report.
Ignatovski, M. (2022). Healthcare breaches during COVID-19: The effect of the healthcare entity type on the number of impacted individuals. Perspectives in Health Information Management.
Medicare.gov. (n.d.). Go digital.
Medicare.gov. (n.d.). Reporting Medicare fraud and abuse.
Small, B. (2022). The top frauds of 2021. Federal Trade Commission.
U.S. Department of Health and Human Services, Office of Inspector General. (n.d.). Medical identity theft.
U.S. Department of Health and Human Services, Office of Inspector General. (n.d.). Submit a hotline complaint.
U.S. Department of Justice, Office of Public Affairs. (2021). National health care fraud enforcement action results in charges involving over $1.4 billion in alleged losses.