Health insurance is a lifeline, designed to ensure individuals and families have access to essential treatments, preventive services, and emergency care. Unfortunately, it’s also become a target for scammers looking to cash in on vulnerabilities. For small to medium-sized businesses (SMBs) in Kentucky, Indiana, and Ohio, understanding and preventing medical fraud is crucial not just for personal protection but also for safeguarding employees and the business itself.

Earlier this year, Change Healthcare, a major player in the healthcare industry, fell victim to a significant cyber-attack, impacting thousands of healthcare providers, insurers, and policyholders nationwide. The incident was so extensive that it put around 50% of all U.S. medical claims at risk. Imagine being in a waiting room with nine others; five of you could potentially fall victim to medical identity theft within the year. The fallout from this type of fraud is severe, potentially disrupting your access to healthcare and compromising the well-being of your employees.

Once your medical information is exposed online, identity thieves can use it to file false claims, purchase expensive prescriptions, and more—all billed to your account. Worse still, some victims don’t realize they’ve been targeted until they face the consequences, such as tax fraud, mortgage fraud, or being denied necessary medical procedures because their benefits have been maxed out by someone else.

Even more alarming is the rise of sophisticated fraudulent schemes perpetrated by unscrupulous organizations. These entities can use your medical information for fake billing, submitting false claims for services you never requested, and then collecting a payday at your expense. Just this past July, 193 defendants, including 76 medical professionals, were charged in various healthcare fraud schemes that resulted in $2.75 billion in false billings to federal programs. Medical fraud is a real and present danger, and it’s essential to know how to protect yourself and your business.

10 Signs Your Medical ID May Have Been Stolen

  1. Unexpected Medical Bills: Receiving bills for services you didn’t receive is a major red flag.
  2. Collection Notices: Being contacted by debt collectors for unpaid medical bills that aren’t yours.
  3. Errors in Medical Records: Finding inaccuracies in your medical records, such as treatments you never had, incorrect diagnoses, or unfamiliar medical histories.
  4. Insurance Issues: Claims being denied because your benefits have been maxed out, despite not using the services.
  5. Notification from Your Insurance Provider: Alerts about claims or services you don’t recognize.
  6. Unknown Accounts: Discovering new health insurance accounts or medical records under your name that you didn’t create.
  7. Discrepancies in Your Explanation of Benefits (EOB): Your EOB statements list services you didn’t receive.
  8. Being Denied Insurance: Difficulty obtaining insurance because of conditions listed in your records that you don’t have.
  9. Calls from Medical Providers: Receiving calls about appointments or follow-ups for treatments you never had.
  10. Unfamiliar Prescriptions: Notices about prescriptions being filled in your name that you did not authorize or receive.

How to Protect Your Business and Employees from Medical ID Fraud

Don’t let your business become the next victim of medical ID theft. Here are several steps you can take to protect yourself, your employees, and your business:

  • Check for Healthcare Breaches: Regularly use searchable databases to find out if your healthcare information has been compromised.
  • Secure Your Records: Store paper copies of medical records in a safe or lockbox to prevent unauthorized access. This is particularly important if a healthcare organization’s system is compromised.
  • Shred Documents: Shred any documents with personal information before disposal.
  • Monitor Medical Records: Regularly request and review medical records from healthcare providers, looking for unfamiliar treatments, diagnoses, or other discrepancies.
  • Review Insurance Bills: Carefully review EOB statements for any services you did not receive. Question unfamiliar or unclear charges and report any discrepancies immediately.
  • Dispose of Prescription Labels: Remove labels from empty prescription bottles before discarding them to prevent identity theft.
  • Monitor Credit Reports: Use AnnualCreditReport.com to get three free reports a year, keeping an eye out for suspicious activity.

Healthcare will always be a target for cybercriminals, and attacks on hospitals, doctors’ offices, and other medical facilities will continue. It’s crucial for SMBs in Kentucky, Indiana, and Ohio to take proactive measures to protect against these threats.

We can help you find out how you’re at risk starting with our FREE Discovery Call. To book your Discovery Call, call us at 502-632-3481 or click here