Monique_Robertson_HIMT 1305 Computer Applications in Health Information Systems
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Feb 20, 2024
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HIMT And Medical
Identity Theft Monique Robertson
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HIMT And Medical Identity Theft Monique Robertson
This type of identity theft first received widespread attention in a report published by the World Privacy Forum 2006 1.
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1 (Dixon, 2006)
What is medical identity theft?
Medical identity theft occurs when someone uses another person's personal information, such as their name, birth date, and insurance details, to fraudulently obtain medical goods or services.
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There are 3 different types of medical identity theft
Friendly Fraud When patients willingly allow a family member or friend to use their health information to commit healthcare fraud.
Outsider Fraud When someone you don’t know, uses your medical identity to commit health care fraud.
Insider Fraud When healthcare providers use your health data for fraudulent activities. In 2019, scammers submitted over $1.7 billion in Medicare claims. This alleged scheme featured medical professionals and telemedicine companies that received illegal kickbacks and bribes
2.
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2 (Elizabeth Layman PhD, 2009)
What Can Someone Do With Your Medical Identity?
1. Obtain illicit drugs under false representation
2. Bill for made-up medical services
3. Falsify medical insurance claims
4. Alter medical records
5. File for fraudulent financial claims
Financial Harm – Results in significant financial damage to those affected. Since medical procedures and services come with a high price tag, an individual posing as someone else can end up costing tens of thousands of dollars for a single operation.
Human Harm – Thieves often change the medical records of their victims, which can be very dangerous if the false information is then used by the victim's doctor. The doctor may make an incorrect diagnosis or prescribe the wrong treatment, which could have serious consequences for the victim's health.
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Two Types of Insider Fraud Institutionalized fraud
Benefits the organization
Can be by an individual or have corporate support
Done on a large scale
Involves multiple players for scheme to work
Individual Fraud
Usually occurs by employees doing the same activities they do as part of their jobs
Occurs during normal working hours
Insider steals or changes small pieces of information
Carried out by employees in lower-
level, nonprofessional, nontechnical jobs who have access to customer records and billing data.
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How Does Medical Identity Theft Affect Consumers
False Incrimination
Health Misdiagnosis
Inferior Credit Score
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Prevention
For Health Care Providers
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Educate Patients On Identity Theft
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Protect Patient Data
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Have A Data Breach Response Plan Ready
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Train Your Staff On Fraud And Red Flags
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Invest In Security Tech And Software
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Prevention
For Health Information Organizations
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Develop system capabilities to prevent, detect, investigate, and mitigate medical identity theft.
•
It is important to implement policies and standards that recognize the potential of medical identity theft. Organizations should include specific policies in their privacy and security policies and procedures to address medical identity theft.
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Prevention
The Data Quality Management Model identifies characteristics of data quality, including accessibility, consistency, currency, granularity, precision, accuracy, comprehensiveness, definition, relevancy, and timeliness
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.
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3 (19-341, 2019)
Additional contact information about medical identity theft and what to do if you suspect you are a victim of Medicare/Medicaid fraud
If you are interested in learning more about medical identity theft or suspect you are the victim of medical identity theft, the following resources can be helpful in addition to the Bureau of Consumer Protection:
Bureau of Consumer Protection https://www.ftc.gov/about-ftc/bureaus-o
ffices/bureau-consumer-protection
Federal Trade Commission
www.consumer.ftc.gov
World Privacy Forum
www.worldprivacyforum.org
In addition to the Bureau of Consumer Protection contact the:
Office of Inspector General
US Dept. of Health & Human Services
Attn: Hotline
PO Box 23489
Washington DC 20026
Toll-free: (800) HHS-TIPS
(800) 447-8477
Online:
oig.hhs.gov/fraud/report-fraud/index.a
sp
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Works Cited
19-341, P. R. (2019, April 9). U.S. Department of Health and Human Services Office of Inspector General
. Retrieved from Department of Justice Logo Office Of Public Affairs: https://oig.hhs.gov/newsroom/media-materials/nationwide-brace-scam/
Contact, H.-O. S. (n.d.). U.S. Department of Health and Human Services Office of Inspector General.
Retrieved from https://oig.hhs.gov/fraud/consumer-alerts/medical-identity-theft/#:~:text=Medical%20identity%20theft%20is%20when,care
%2C%20and%20wastes%20taxpayer%20dollars
.
Dixon, P. (2006, May 6). World Privacy Forum
. Retrieved from https://www.worldprivacyforum.org/2006/05/report-medical-identity-theft-part-i-summary/
Elizabeth Layman PhD, R. C. (2009, September 16). NIH National Libray of Medicine
. Retrieved from Research and Policy Model for Health Informatics and Information Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781730/
Harris, K. D. (2013, October). Medical Identity Theft Recommendations for the Age of Electronic Medical Records.
Retrieved from California Department of Justice: https://oag.ca.gov/sites/all/files/agweb/pdfs/privacy/medical_id_theft_recommend.pdf
(Dixon, 2006)
[1]
(Elizabeth Layman PhD, 2009)
[2]
(19-341, 2019)
[3]
(Harris, 2013)
(Contact)
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