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CMS targets medical ID theft

May 23, 2012

The U.S. Centers for Medicare & Medicaid Services (CMS) is launching a drive to help keep health care practitioners from becoming victims of identify theft.

“Fraud affects everyone,” noted Peter Budetti, M.D., J.D., the CMS Deputy Administrator for Program Integrity, on the agency’s blog last month.

Identity theft has become a major concern for virtually all segments of modern society, the CMS noted. In the course of its ongoing efforts to fight fraud and abuse in the Medicare system, the CMS frequently encounters cases in which patients are victims of identity theft. However, health care practitioners are also vulnerable to a type of fraud called “medical identity theft,” Dr. Budetti emphasized.

“Medical identity theft happens when a fraudster uses your unique medical identifiers to bill insurance for items or services that you never provided or prescribed. Examples of these medical identifiers could be your National Provider Identifier (NPI), Tax ID Number (TIN), and medical licensure information. You pay for this kind of fraud with increased financial liabilities – you may be expected to pay taxes on earnings you never received, or repay insurance companies for payments on items or services that you never provided. You may also become the physician of record for services you had nothing to do with.”

The CMS suggests seven steps practices can take to prevent such identity theft.

1. Keep your medical information up to date. Report any changes to Medicare, Medicaid, and other insurance companies, such as opening and closing of offices and moving between group practices.

2. Review billing notices. Actively review your Medicare remittance notices to make sure there are no items or services listed that you didn’t provide, including payments to you for services you didn’t provide.

3. Protect your medical information. There are things you can do to better protect your information. For example, before giving out your medical identifiers to potential employers or other organizations, check them out to be sure they’re legitimate. Only give your information to trusted sources.

4. Train your staff. Make sure your employees know the proper way to use and distribute your medical information, such as on prescription pads, electronic health records, and other important documentation.

5. Educate your patients. Patients are victims, too. Medical identity theft leads to higher insurance costs. Also, if patients are charged for items or services they never received, they may be denied in the future when they really need them. Tell patients to be on the lookout for fraudulent activity on their explanation of benefits statements and how to report fraud when they see it.

6. Report any suspected medical identity theft. If you believe you may have been the victim of identity theft, call the CMS program integrity investigative contractor in your region (see http://tinyurl.com/MedicarePSCs). You may also report any suspected cases of medical identity theft to the Office of the Inspector General of the U.S. Department of Health & Human Services at 800-HHS-TIPS (800-447-8477) or http://oig.hhs.gov/fraud/report-fraud.

7. Protect your prescription pads. Keep your prescription pads in a safe and secure environment, so they can’t be used by fraudsters to obtain prescriptions you never prescribed.

Additional information on the initiative to prevent Medicare fraud can be found at www.stopmedicarefraud.gov.

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