Medical identity theft happens when a criminal uses stolen personal information (such as a Social Security number, health insurance number, or Medicare account) to obtain medical services, prescription drugs, or other health care in someone else’s name. To stay safe, we recommend keeping health insurance cards in a safe place, and thoroughly reviewing healthcare documents so you can act quickly if you spot possible fraud.

If someone claiming to be from your doctor's office calls unexpectedly and asks for sensitive personal information, what should you do?

Before you share any details, be aware that personal and medical information can be highly valuable to fraudsters.

In fact, in 2022, the Federal Trade Commission (FTC) received nearly 28,000 reports of medical identity theft.

Here at Allstate Identity Protection, we’ve seen the impact. In the first quarter of 2022, our Identity Fraud in Focus report noted a 66 percent year-over-year increase in medical fraud reports from our members.

While our overall case numbers are still relatively low, this is a particularly alarming fraud type. It’s difficult to detect, and it even has the potential to interfere with your health — because when a scammer receives healthcare under someone else’s name, it can lead to errors in the victim’s medical records.

Read on to learn more about how identity thieves may try and get your medical information, and what you can do to stay safe.

What is medical identity theft?

Medical identity theft happens when fraudsters use a victim’s name, health insurance number, or Medicare account to obtain medical services or devices.

Fraudulently obtaining prescription drugs, surgery, or other health care under someone else’s name are all examples of medical identity theft.

Fraudsters may even use stolen personal details to file an insurance claim for a phony or unnecessary treatment in order to get a payout from the insurance company.

But how do identity thieves get the information they need to commit medical identity fraud? In some cases, criminals purchase stolen personally identifiable information (PII) or health insurance information from the dark web. Other times, thieves use information that a victim knowingly supplied, or was tricked into supplying.

Often, patient files are also shared with third-party vendors across a number of systems and devices.

If one of those third parties experiences a data breach, or if a healthcare system suffers a security incident, patient information can wind up exposed.

No matter how medical identity theft occurs, it can introduce errors in patient records, leading to misdiagnosis.

In addition, according to the Federal Bureau of Investigation (FBI), fraudulent medical billing can increase health insurance premiums and taxes for everyone.

Quick Tips

Medicare scams may spike during open enrollment

The Federal Communications Commission warns that Medicare open enrollment — which usually runs from October to December — is a busy time for medical identity scammers and robocallers.

Keep in mind that Medicare, the Social Security Administration, and insurance providers typically do not call you with questions about your plan or to update your plan over the phone. A call like this is likely fraud, even if the caller ID looks legit.

How to know if you’re a victim of medical identity theft

Medical identity theft can be tricky to spot.

For example, credit monitoring services like ours can help you quickly identify fraudulent credit accounts. But unpaid medical debt won’t surface on your credit report until a full year after it’s gone to a collection agency, so this fraud type can fly under the radar for a longer period of time.

“Victims of medical identity theft don’t typically discover the issue until they’re contacted by a debt collector, or until they see an unfamiliar medical collection notice on their credit report,” says Kelli Starks, Senior Restoration Specialist at Allstate Identity Protection.

By then, the thief may have racked up hundreds or thousands of dollars of medical debt under the victim’s name.

So, it’s important to know these red flags of medical identity theft:

  • You receive a bill for medical services that you haven't received

  • You receive a call from debt collectors about a medical debt that you do not owe

  • There are medical collection notices on your credit report that you do not recognize

  • You receive an unexpected notice from your health plan saying you reached your benefits limit

  • You are denied insurance coverage because your medical records show a pre-existing condition that you do not have

If you’re an Allstate Identity Protection member and you see something on your health records that doesn’t look right, give us a call. Our identity specialists are available 24/7 to walk you through the issue you’re experiencing. 

How to protect yourself from medical identity theft

Awareness is key when it comes to avoiding medical identity theft — so try these tips to better protect yourself.

Consider sharing them with your friends and family too:

  • Treat your insurance card like a credit card. Keep insurance or Medicare cards in a safe place. If they’re lost or stolen, alert your insurance provider immediately; they may issue you a new number. 

  • Beware of phishing and imposter scams. Criminals may contact you by phone, text, or email and attempt to trick you into sharing PII. If you get an unsolicited request to share sensitive information from someone who claims to be a healthcare provider, hang up and contact your doctor or healthcare system directly.

  • Be wary of offers of free medical services or equipment. Criminals may reach out with an offer of “free'' durable medical equipment (DME), such as a wheelchair or a back brace. This is a common ploy to get patients to share their health insurance or Medicare information. If you need to order medical equipment, contact a trusted physician for guidance. 

  • Review healthcare-related documents carefully and thoroughly. This includes health bills, explanation of benefits (EOB), and Medicare Summary Notices (MSN). When reviewing these documents, make sure that they match the healthcare services and medications that you actually received. If you have any questions or concerns — or if you spot any inconsistencies — immediately contact your insurance and healthcare providers. 

  • Request a full list of benefits paid in your name by your health insurance provider. Doing this once a year can help you spot any charges that you don’t recognize or didn’t make as soon as possible. 

  • Likewise, request a copy of your health record annually. Check that everything on your health record is accurate, and store it somewhere safe in case you need to dispute any diagnoses or information in the future.