What Is Medical Identity Theft and Why Should You Care?
You've probably heard about credit card fraud or identity theft. But there's another type of fraud that's becoming increasingly common—and it can be even more damaging: medical identity theft.
Unlike financial identity theft, where thieves might run up charges on your credit card, medical identity theft can affect your actual medical care. And it's harder to detect and fix.
What Is Medical Identity Theft?
Medical identity theft happens when someone uses your personal information—like your name, Social Security number, or insurance details—to get medical care, buy prescriptions, or submit fraudulent claims to your insurance company.
This might sound like someone else's problem, but the consequences can be devastating:
Your insurance coverage could be maxed out by fraudulent claims, leaving you without coverage when you actually need it. Your medical records could be contaminated with someone else's health information, potentially affecting your diagnosis or treatment. You could face collections for medical bills you never incurred. Your credit score could be damaged by unpaid fraudulent medical bills.
How Does It Happen?
Medical identity theft can occur in several ways:
Data Breaches
Healthcare organizations are frequent targets for hackers. When hospitals, insurance companies, or medical practices experience data breaches, thousands or even millions of patient records can be compromised.
In recent years, major healthcare data breaches have affected millions of Americans. Unlike credit card breaches where your card can be quickly canceled and replaced, your medical information can't be changed.
Stolen Insurance Cards
If someone steals your wallet or purse, they don't just get access to your credit cards—they get your insurance card too. With your insurance information, they can receive medical care in your name.
Insider Threats
Sometimes medical identity theft is committed by people who work in healthcare. They have access to patient records and insurance information and can use or sell this data.
Family Members
Unfortunately, some medical identity theft is committed by family members or people close to you who have access to your insurance information. They might use your insurance to get care for themselves or their own family members.
Real-World Impact
Medical identity theft isn't just a theoretical problem. Here's what can happen:
Maxed out insurance benefits: Someone uses your insurance until you hit your coverage limits. When you need care, you discover you have no coverage left.
Wrong information in your medical records: The thief's medical conditions, medications, and treatment history get mixed into your records. This could lead doctors to make incorrect decisions about your care.
Bills for services you never received: You get collection notices for medical care you never got, in places you've never been.
Denied coverage: Your insurance company might deny your legitimate claims because they think you've already received care (when actually the thief did).
Warning Signs of Medical Identity Theft
Watch for these red flags:
- Bills for medical services you didn't receive
- Collection notices for medical debt that isn't yours
- Insurance statements showing services or providers you don't recognize
- Calls from collection agencies about medical bills you don't owe
- Explanation of Benefits (EOB) forms showing claims you didn't file
- Being denied insurance coverage or prescriptions because your records show you already received them
- Medical records containing information about conditions you don't have or treatments you didn't receive
Why It's Hard to Fix
Medical identity theft is more complicated to resolve than financial identity theft:
Medical records are permanent: Unlike a credit card that can be canceled, your medical records can't be deleted. Separating the fraudulent information from your real medical history is complex and time-consuming.
Multiple parties are involved: You might need to work with hospitals, insurance companies, collection agencies, and law enforcement—each with their own processes.
Healthcare privacy laws: HIPAA and other privacy laws, while protecting your information, can also make it harder to investigate and resolve identity theft.
It's not always discovered quickly: You might not realize someone has stolen your medical identity until you need care and discover problems with your insurance or medical records.
How to Protect Yourself
While you can't prevent all medical identity theft, you can reduce your risk:
Treat your insurance card like a credit card. Don't share your insurance information unnecessarily, and report lost or stolen cards immediately.
Review your Explanation of Benefits (EOB) statements. Look at every EOB from your insurance company and question anything you don't recognize.
Check your medical records regularly. You have the right to review your medical records. Look for information that doesn't belong to you.
Be careful with your personal information. Don't give out your Social Security number or insurance information unless necessary.
Secure your documents. Keep insurance cards, medical bills, and EOB statements in a safe place. Shred documents before throwing them away.
Monitor your credit report. Medical identity theft often leads to unpaid medical bills that affect your credit.
What to Do If It Happens to You
If you suspect medical identity theft:
Contact your insurance company immediately. Report the fraudulent activity and ask them to flag your account.
Request copies of fraudulent claims. You're entitled to see any claims filed under your insurance.
File a police report. This creates an official record of the theft and may be required by your insurance company.
Contact the Federal Trade Commission (FTC). File a report at IdentityTheft.gov.
Review and correct your medical records. Work with your healthcare providers to add correct information and flag fraudulent entries.
Place a fraud alert on your credit reports. This makes it harder for thieves to open new accounts in your name.
Getting Help
Monitoring your medical claims and insurance activity takes time and attention—especially if you're managing care for yourself or a loved one while dealing with health issues.
Some services help monitor your medical claims for signs of fraud and billing errors. Tools like HealthLock review your claims automatically and alert you to suspicious activity, helping catch problems before they become major issues.
The Bottom Line
Medical identity theft is a growing problem that can affect your healthcare, your finances, and your medical records. Unlike credit card fraud, it can't be fixed with a simple phone call.
The best defense is awareness. Review your medical statements carefully, protect your insurance information, and act quickly if you spot suspicious activity.
Your medical identity is valuable—to you for getting proper care, and to thieves who want to exploit it. Protecting it is just as important as protecting your financial identity.
Protect Yourself from Healthcare Fraud
Medical identity theft can destroy your credit and contaminate your medical records. HealthLock monitors your medical claims for suspicious activity, duplicate billing, and identity theft, catching fraud before it ruins your finances or health. HealthLock's members have saved over $243 million by catching billing errors, denied claims, and fraud before they became major problems.
Disclaimer: We're not medical billing experts or attorneys—we're patients and caregivers sharing resources to help you navigate a broken system. This information is for educational purposes only and should not be considered medical or legal advice.
Affiliate Disclosure: This site may contain links to services like HealthLock that help monitor medical claims and billing. We may earn a commission if you sign up through our links, at no extra cost to you. We only recommend services we believe can genuinely help.