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Medical identity theft happens when someone uses your identifying or insurance information to obtain care, prescriptions, medical devices, or submit health-insurance claims. It can affect more than your finances: false diagnoses, test results, medicines, or procedures may be added to your medical record. Check both insurance statements and provider records, and act promptly on anything you do not recognize.
This guide is for U.S. consumers. The Federal Trade Commission (FTC) defines the issue in its September 2024 consumer guidance.
What is medical identity theft?
Medical identity theft is the unauthorized use of someone’s personal information—such as a name, Social Security number, health-insurance account number, or Medicare number—to get medical care, see a doctor, obtain prescription drugs or medical devices, or submit claims to an insurer. The FTC and the HHS Office of Inspector General (OIG) describe forms of this misuse involving private insurance and Medicare.
The consequences can span clinical records and billing. Another person’s diagnoses, prescriptions, procedures, or test results may be mixed into your file, potentially affecting decisions made by clinicians who rely on it. Unauthorized claims can also consume insurance benefits, generate bills, or lead to collection activity. These warning signs warrant investigation, but they are not proof on their own: billing mistakes happen too.
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How can I tell if someone is using my health insurance?
Review insurer statements, including Explanation of Benefits (EOB) notices, and look for services, prescriptions, providers, or dates that do not match the care you received. Also watch for:
- A medical bill or EOB for care or medicine you did not receive.
- A debt collector seeking payment for an unfamiliar medical service.
- Medical collection activity you do not recognize on a credit report.
- A notice that your insurance benefits have reached a limit you did not expect.
- Diagnoses, tests, medications, or procedures in a provider’s record that are not yours.
Check with the provider and insurer to verify a suspicious charge before concluding that it is fraud. An unfamiliar claim may be an error, but it still deserves a clear explanation.
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How can I protect my medical information?
Secure paper records and mail
Keep medical and insurance records, enrollment forms, insurance cards, prescriptions, prescription bottles, bills, and EOB notices in a safe place. Shred paper documents containing medical information before throwing them away; the FTC specifically recommends shredding these records. For prescription containers that are difficult to shred, obscure identifying information. Retrieve mail promptly, and consider electronic delivery of bills and EOBs if that suits your needs.
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Question requests for sensitive information
Ask a medical office why it needs your Social Security number and whether it can use another identifier or only the last four digits. When anyone requests your insurance or Medicare number or health details, ask why the information is needed, how it will be protected, and whether it will be shared.
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Do not give medical details to an unexpected caller, email, or text. Instead, contact the provider or insurer using a number you have independently verified, such as the one on your insurance card, or visit a known official website. For Marketplace matters, HealthCare.gov’s fraud and scam guidance advises relying on official government websites and not sharing personal, financial, or health information with unverified contacts.
Know what HIPAA does—and does not—cover
HIPAA is not a universal privacy guarantee for every app or service that handles health-related information. HealthIT.gov explains that HIPAA’s Privacy and Security Rules protect information held by covered healthcare providers and health insurers, but do not apply when you share information with an organization that is not covered. Check a service’s privacy terms and coverage rather than assuming it is protected because it relates to health.
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What should I do about a medical bill I don’t recognize?
Work through the insurer and the organizations that hold the relevant records. Keep copies of bills, EOBs, correspondence, and any report you file.
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- Verify the service with the provider. Contact the doctor, hospital, clinic, pharmacy, laboratory, or other organization named in the claim. Ask what service was provided, when it happened, and which records or billing details support the charge.
- Request records from relevant organizations. Contact providers, pharmacies, laboratories, and health plans where your information may have been used. Review their records for care, diagnoses, medicines, procedures, or test results that do not belong to you.
- Report the identity theft. Use IdentityTheft.gov to report it and follow the personalized recovery plan. The FTC advises sending the resulting FTC report to your insurer’s fraud department.
- Check for related credit effects. Review your credit reports for unfamiliar medical collection activity. The FTC points consumers to AnnualCreditReport.com and its identity-theft recovery instructions for related billing problems.
How do I correct an error in my medical records?
Contact the provider that holds the incorrect information and make the request in writing. Identify each error, explain what is wrong, include relevant supporting information, and keep a copy and proof of delivery. Ask the provider to correct the information and notify other providers that may hold the same error. The FTC says the provider must respond to a correction request within 30 days.
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Separately tell your health plan about any claim you believe is fraudulent; correcting a clinical record and resolving an insurance claim are related but distinct tasks. Keep the provider’s response and the insurer’s decision with your records.
What if the suspicious charge involves Medicare?
HHS OIG recommends first contacting the provider about questionable charges. If the issue is not resolved, contact 1-800-MEDICARE or your local Senior Medicare Patrol. HHS OIG also provides a fraud hotline reporting route for suspected Medicare fraud. Follow the instructions on the official pages, since contact details and reporting processes can change.
Do identity-monitoring services prevent medical identity theft?
Monitoring, recovery assistance, and identity-theft insurance are commercial service categories described by the FTC, but they are optional and may cost extra. Most identity-monitoring services do not alert users when someone misuses Medicare or Medicaid benefits. A paid service should not be treated as comprehensive protection; it does not replace reviewing claims, securing documents, and contacting providers or insurers about suspicious activity. The FTC’s identity-theft protection services guidance describes these limitations.
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