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Medicare Identity Theft is on the Rise. How to Avoid Becoming a Victim


Over the last few years, healthcare-related fraud has exploded, driven in part by the COVID pandemic as well as the increasing number of seniors going on Medicare. As with any type of identity theft, medical identity theft can be devastating, particularly for the most vulnerable among us—seniors with health concerns relying on their Medicare benefits.

Fraudulently obtained medical information is used routinely by fraudsters to fill prescriptions, receive medical treatment, purchase medical equipment, and submit fraudulent insurance claims in your name. The damage caused can go well beyond finances; it can threaten your health.

It Could Change Your Medical Care

For example, if fraudsters use your medical identity to access healthcare, it could affect the accuracy of your medical records. If the fraudster’s medical conditions and care are listed along with your own, it could affect your care.

If you’re not aware that your medical identity has been stolen, you won’t know about the incorrect information. That’s why healthcare providers ask that you review your medical history before seeing your doctor.

You could lose coverage: If a fraudster files an insurance claim using your Medicare ID, it becomes part of your claims record. That could count against your coverage limits for medical care or prescription drugs, resulting in a delay or denial of treatment. If a fraudster’s medical diagnosis of a pre-existing condition shows up on your medical record, your Medigap insurer could deny you coverage.

Your out-of-pocket costs will increase: If a fraudster uses your Medicare ID to pay for medical treatment or drugs, you are responsible for unpaid copays or expenses. If you’re unaware that your Medicare ID has been stolen, you will likely pay these bills.

It could hurt your credit rating: While medical debt doesn’t affect your credit rating, an unpaid medical debt that has gone to collections can, which can hurt your chances of qualifying for a credit card or refinancing your mortgage. And fixing your credit record can take time and money.

If you experience any of these circumstances, you have likely become a victim of fraud. You need to contact your insurance provider immediately to get specifics and correct your record.

How Fraudsters Steal Your Medicare Identity

While Medicare has experienced data breaches in the past, the most common way fraudsters steal medical identities is through impersonation. They can play the role of a Medicare representative, government employee, healthcare worker, or insurance representative, contacting you through phone calls, letters, emails, or text messages.

While fraudsters can sound very convincing when talking about something important to you, there are several red flags to look for that can alert you to a possible scam:

  • You receive an unsolicited call from someone claiming to work for Medicare. That doesn’t happen unless you ask a Medicare representative to contact you.
  • A Medicare imposter asks you for your ID number to activate your card or confirm you received one.
  • Someone claims there has been suspicious activity on your Medicare account and says your coverage may be suspended if you don’t verify your ID.
  • You are threatened with cancellation of your coverage unless you provide personal information.

Fraudsters also try to trap you by using ‘phishing’ emails—emails designed to look legitimate as if sent from Medicare, an insurer, or a government agency. The emails may contain the same type of claims described above, except they provide you with a link that takes you to a bogus website to collect your information.

How to Prevent Medicare ID Theft

The first rule to follow for preventing Medicare ID theft is not to provide any personal information to anyone unless they can verify their identity. Essentially, that means anyone who calls or emails you. You can verify the identity of anyone calling as a Medicare or insurance representative by calling Medicare directly at 1-800-633-4227.

Here are additional best practices to keep your identity safe:

Do not share your Medicare number with anyone: Treat your Medicare ID card as you would your driver’s license or Social Security card. There’s no reason to provide your number to anyone except your providers or someone you trust implicitly.

Treat your Medicare ID like a credit card: While you should always have your Medicare ID card with you, don't take it out where others can see it.

Protect your medical and insurance files: Keep your medical and insurance records filed away and shred those containing your Medicare and Social Security numbers. If you can't or don't want to shred them, black out the numbers with a marker. Also, clear your mailbox daily to prevent fraudsters from stealing sensitive information.

Review your records frequently: Review copay receipts, Medicare summary notices, treatment summaries, and other statements looking out for suspicious activities. Add your medical appointments, tests, and prescription refills to a calendar and check them against your claims activity on your statements.

Get identity theft protection: Many property insurers offer identity theft protection, which can reduce the risk and impact of an occurrence. They not only provide financial protection but also services to help you recover your identity and fix your records.

What to do if You Suspect Your Medicare ID has been Stolen

If you suspect your Medicare ID has been stolen, contact Medicare immediately at 1-800-633-4227. You can also request help on the Health and Human Services website at the Office of the Inspector General's hotline. The Medicare website also provides the information you will need when reporting the fraud.

If you have been a victim of Medicare fraud, you may need help restoring your identity. You can start by notifying the Federal Trade Commission at identitytheft.gov or calling 877-438-4338.

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This article contains general information only. Sunflower Bank is not, by means of this article, rendering accounting, financial, investment, legal, tax, or other professional advice or services. This article is not a substitute for such professional advice or services, before making any decisions related to these matters, you should consult a qualified professional advisor.