As discussed in the August issue of The Medical Strategist, medical identity theft is a real issue, which, with the explosion of medical records becoming electronic, is at a much greater risk of exposure.

Just as identity theft can cause extreme distress, wreck your credit rating and rack up huge expenses to taxpayers, medical identity theft can do the same but is worse. Wrong information entries can be repetitively entered into your personal medical records and the result can be life threatening.

The World Privacy Forum, a non-profit research group, found that there have been more than 20,000 reports of medical identity theft in the past 15 years and is on the upswing.

On October 15,2009, Kathleen Sebelius, the Secretary of Health and Human Services in conjunction with Assistant Attorney General Tony West drew attention to Medicare Fraud and produced a 2 page brochure providing tips to help seniors and Medicare beneficiaries to protect themselves.

Secretary Sebelius states, "Preventing medical identity 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."

The brochure called "Stop Medicare Fraud can be obtained at: www.StopMedicareFraud.gov. This is a simple, easy to understand give-away produced by the HHS Office of the Inspector General (OIG) that you could supply to your patients and friends. Information within the pamphlet is summarized below.

Common Fraud Schemes should elicit your hang-ups and to turn your back and run.

Should you receive a call from someone conducting a health care survey and asking for your Medicare number-hang up.

Telephone marketers may claim to be from Medicare or Social Security and ask for payment over the phone or Internet. This is a way to steal your money. Again- hang up.

If you are approached in public areas and offered free services or items in exchange for your Medicare number- walk away.

Detect and Defend

Whenever services are rendered for medical care, an EOB or explanation of benefits is generated. It is crucial to check those as well as the medical bill, credit report and Medicare summary notice if applicable.

Entries that you should observe:
· Did you receive the medical services or equipment listed?
· Check the dates of services and charges
· Repeat of services
· Review your credit report to ensure that there are no outstanding bills for medical services or equipment that are not yours
· Scour any received collection notices for medical service to ensure that it really applies to you

Who to Report Fraud or Inconsistencies to:

For questionable charges- your health care provider
For Unresolved provider charges- Medicare
For Medicare fraud- Department of Health & Human Services Office of Inspector General
For misuse of personal information- the Federal Trade Commission

The Federal Trade Commission issued a regulation to prevent identity theft called The Red Flag Rule. Initially this was to go into effect August 1, 2009. It was successfully pushed back to November 1, 2009 so that facilities had time to comply with the guidelines.

According to the Red Flag Rule, healthcare facilities which includes physician offices, clinics and hospitals, are required to have a risk assessment program in place to address problems in their billing process that might expose their patients to identity theft or medical identity theft (MIT).

Medical Identity theft enables an individual to get medical services rendered, be it healthcare, examinations, tests, Medicare or Medicaid benefits or insurance reimbursement by using someone else's vital information such as an insurance policy number or social security number.

The program analyzes the facility risk for insurance fraud and establishes means by which "red flags" set alarms for any breaches to privacy of patient information.

The office must also have steps in place to not only prevent such theft but also identify it and respond accordingly if theft is detected.

Some key elements include:
· Training staff to detect fraud
· Checking photo IDs before providing medical services
· Ensuring that identification including credit cards or driver license matches the insurances card
· Monitoring who is accessing patient files
· Surveying patterns of suspicious activity in patient accounts
· Reporting detected fraud immediately, even before billing

Although the rule originated in a 2003 law for banking institutions, it was generally applied to all business that extends credit to individuals. According to law, deferring debt is considered credit even though interest is not charged. Because bills are generated when service is rendered, the FTC views medical bills not paid at the time of the visit, as extending credit.

In defense of physicians, the AMA disputes the fact that healthcare sites are creditors and instead that the insurance carriers that have the submitted insurance claims are the creditors. In addition, enforcement of the regulation might force some physicians to demand payment in full up front.

Starting November 1, doctors who do not comply could be fined $2,500 per violation.

The FTC supplies a how-to-guide for all businesses on their website to help in setting up the appropriate program. For offices that are instituting EMR (electronic medical record) programs, most certified ones have red flag compliance within the software.

In a short time from now my book will be available on EMRs and how to choose the system right for you.

Possible titles include:
· EMR Manual: How to Choose the Electronic Medical Record System that's Best for You
· Electronic Medical Record System: Choosing without Loosing
· EMR Manual: Choosing the right electronic medical record system without breaking the bank
· Electronic Medical Record Manual: Choosing the EMR system with minimal frustration
· Electronic Medical Record Manual: Choosing the EMR system that's right for you

You may vote for one of the above titles or you may come up with one of your own.

The prize will be a FREE copy of the book which is a $397.00 value.

The deadline will be 12/15/09. You may enter more than once and you may invite your friends to enter as well. Good luck to all of you.

For my subscribers,colleagues and friends: You can copy any content in this newsletter for your own use as long as the following accompanies it and the link is live:
Reprinted by permission of Internet copywriter Barbara Hales. For more information on innovations and tips, subscribe to the Medical Strategist at:
http://www.TheWriteTreatment.com

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