$100 Billion-A-Year Medical Care Fraud

Healthcare fraud is big business. Last year scammers and organized crime groups bilked an estimated $100 billion last year according to a new article Health care: A ‘goldmine’ for fraudsters from CNNMoney.com.

Medical Identity theft is the most lucrative aspect of the medical fraud business, and the most common method of gaining access to personal medical records is when someone with legitimate access to the data sells the information to criminals. But that’s changing.

According to the CNN article “Increasingly, criminal groups are hacking into digital medical records so that they can steal money from the $450 billion, 44-million-beneficiary Medicare system — making the government, by far, the “single biggest victim” of health care fraud, according to Rob Montemorra, chief of the FBI’s Health Care Fraud Unit.”

To learn more about the risks you face when your medical records go online, see my blogs:

While the government is the “single biggest victim”, every individual whose records are stolen will feel the pain.

The most common way scammers and criminals make their money is by sending in false bills to insurance companies and Medicare for medicines, equipment, in-home health care, or treatments that were not prescribed or requested.  Criminals also ‘resell’ an individual’s medical records to an uninsured person in need of medical care.

While the aim of the criminals behind medical ID theft and fraud is to steal money, the tampering with your medical information can place you at serious risk if doctors base medical decisions about your care on the falsified information in your file.

The government isn’t the only one footing the bill. In addition to the indirect costs to the government and insurance companies that every consumer pays for medical fraud, the average cost to an individual victim of medical ID theft was close to $1,200 according to Javelin Strategy & Research, a research firm specializing in trends in security and fraud initiatives. Javelin’s research also found that in 2008 the average incident of health care identity fraud netted the criminal $19,000, which is four times the earnings of overall ID theft.

In addition to the risk to your medical records, these thieves also gain access to the information that accompanies your records – including your name, address, phone number, social security number, insurance company, and more – placing you at high risk for traditional ID theft as well.

Stay vigilant

Always check your insurance benefits statements to see if there are charges or claims that are not yours. Notify your insurance company if your financial ID has been stolen, and notify your financial institutions if your medical ID has been stolen.



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