Every day both individual fraudsters and organized criminal enterprises attack and defraud federal and state agencies and health care systems of as much money as they can. Just as Willie Sutton robbed banks because "that's where the money is," criminals are constantly looking for new ways to defraud government programs, insurers, doctors, hospitals, and ordinary individuals. The increasing use of the Internet to streamline applications, operations, and access to information opens up new avenues for criminals to operate at a much lower risk than robbing banks. In response, government agencies and health care systems are working to take the steps necessary to combat identity theft and protect their programs and members from its ramifications.
The Impact of Medical Identity Theft
Integrating the Internet into application, enrollment, and delivery of health care services can result in significant savings and overall operational efficiencies through streamlined processing. Medicaid, the single largest government health care program, spends more than $550 billion (1) annually in providing services--anything that can cut overhead and administrative costs means more effective care delivered to patients. But the Centers for Medicare and Medicaid Services estimates (2) that more than 10 percent of that is being paid improperly, with at least 3 percent attributed to eligibility authentication problems. This means that by increasing the ability to keep the bad guys out of our programs could save billions of dollars.
And that's just the direct financial impact. Besides driving up health care costs, it also means the health records have probably been corrupted for persons victimized by health care identity theft. In an August 2016 article, (3) Consumer Reports estimated that one in five of these victims suffered a negative health impact. Moreover, the onus is generally on the victims to correct their affected health records.
While it is estimated that medical identity theft is growing at more than 22 percent (4) each year, the problem is far from limited strictly to health care identities. According to the Identity Theft Resource Center, (5) as of August 16, 2017, there have been 917 data breaches this year so far compromising more than 16 million records containing personally identifiable information. All individuals, government agencies, as well as health care providers, need to be on high alert to ensure they are not impacted by these criminals.