Physician Medical Identity Theft

Abstract

IT TOOK SEVERAL MONTHS FOR ONE PHYSICIAN TO LEARN THAT she was a victim of medical identity theft. This realization occurred after patients reported that her name was on their Medicare Summary Notices although they had never seen her. A fraudulent clinical practice had enrolled in Medicareusinghernamewithoutherknowledge.Anotherphysician had retired from clinical practice but decided to work part-time. Nearly 2 years after sending out job applications, he was asked by Medicare to return more than $350 000 in overpayments made to a practice he had interviewed with but never joined. The Department of Treasury began to garnish his Social Security payments for unpaid debts. Investigation revealed that both stolen identities were part of a complex Medicare fraud scheme that victimized numerous physicians and resulted in the criminal conviction of 6 perpetrators. The physicians’ identities have been restored and their financial liabilities and enrollment records have been cleared, but this situation highlights the importance of understanding and preventing physician medical identity theft. Scope of the Issue Medical identity theft is the appropriation or misuse of a patient’s or physician’s unique medical identifying information to obtain or bill public or private payers for fraudulent medicalgoodsorservices.Forphysicians, this information includes theNationalProviderIdentifier(NPI),TaxIdentificationNumber (TIN), and medical licensure information. Recent data revealthatmorethan3600casesof(physicianandpatient)medical identity theft were reported to the Federal Trade Commission (FTC) in 2009, with more than 12 000 cases reported between 2007-2009. It is likely that substantial medical identity theft is unreported. FTC data also show that 32% of thefts are discovered more than 1 year after they occur. The Center for Program Integrity (CPI) at the Centers for MedicareM medical job