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Tips to Prevent Medical Identity Theft and Medicare Fraud

  • Published: 2009-10-16 (Revised/Updated 2016-06-13) : Author: HHS Press Office
  • Synopsis: Medical identity theft occurs when someone steals a patient's personal information such as name and Medicare number.

Secretary of Health and Human Services Kathleen Sebelius and Assistant Attorney General Tony West today highlighted the Obama Administration's work to fight Medicare Fraud and released new tips and information to help seniors and Medicare beneficiaries deter, detect and defend against Medical identity theft.

Medical identity theft occurs when someone steals a patient's personal information, such as his or her name and Medicare number, and uses the information to obtain medical care, to buy drugs or supplies, or to fraudulently bill Medicare using that patient's stolen identity. The new tips and a printable brochure were produced by the HHS Office of the Inspector General (OIG).

"When criminals steal from Medicare, they are stealing from all of us. That's why fighting Medicare fraud is one of the Obama Administration's top priorities," said Secretary Sebelius. "Preventing medical identify theft is an important part of our work to stop Medicare fraud, and these tools will give seniors important information about how to deter, detect and defend against ID theft and fraud."

"This Administration is committed to guarding Medicare against fraud and abuse," noted Assistant Attorney General West. "The Department of Justice (DOJ), in collaboration with our partners at the Department of Health and Human Services (HHS), will continue to protect the integrity of the nation's public health programs and vigorously pursue those who seek to take advantage of our most vulnerable citizens."

"Medical identity theft can disrupt your life, damage your credit rating, and threaten your health if inaccurate information ends up in your medical records," added HHS Inspector General Daniel R. Levinson. "OIG's special agents frequently uncover fraud schemes that involve the sale and use of stolen Medicare identification numbers. We're cracking down on these schemes and working to help stop medical identity theft before it happens."

The materials released today include practical steps to help "deter, detect, and defend" against medical identity theft. Beneficiaries are reminded to beware of offers of free medical equipment, services, or goods in exchange for their Medicare numbers. Beneficiaries are also encouraged to regularly review their Medicare Summary Notices, Explanations of Benefits statements, and medical bills for suspicious charges and to report suspected problems.

The effort to help prevent medical identity theft is one part of the Obama Administration's work to crack down on Medicare fraud. In May, Attorney General Eric Holder and Secretary Sebelius announced the creation of a new inter-agency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud. The HEAT team includes senior officials from DOJ and HHS. HEAT team efforts include the expansion of joint DOJ-HHS Medicare Fraud Strike Force teams that have been successfully fighting fraud in South Florida and Los Angeles to additional cities including Detroit and Houston. Established in 2007, these teams have a proven record of success using data analysis techniques and community policing to identify, investigate and prosecute on-going fraud.

The Centers for Medicare & Medicaid Services (CMS) has undertaken other steps to fight fraud and protect beneficiaries who buy durable medical equipment or rely on home health services. On October 1, all durable medical equipment suppliers across the nation, except for pharmacies, must be certified by Medicare, a requirement that assures beneficiaries that their suppliers are valid businesses and meet Medicare's financial and quality standards.

At today's event, Sebelius also highlighted the SMP programs and was joined by SMP volunteer Joanna T. Gibson of Felton, Del. Formerly known as Senior Medicare Patrol programs, the SMP programs are funded by HHS' Administration on Aging and help Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud. Because this work often requires face-to-face contact to be most effective, SMPs nationwide recruit and train nearly 5,000 volunteers every year to help in this effort. Most SMP volunteers are both retired and Medicare beneficiaries and thus well-positioned to assist their peers.

"We all have to pitch in and do what we can to prevent our Medicare dollars from being wasted on fraud," said Gibson. "And we can start by learning more about what Medicare covers, reading our Medicare statements, and reporting provider charges that just don't seem right."

To report suspected Medicare fraud call the Inspector General's toll-free Hotline at 800-447-8477 (800-HHS-TIPS). The toll-free TTY number is 800-377-4950.

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