Health Care Fraud Through Identity Theft and Impersonation

Health care fraud is committed when someone intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits payable. One of the most common varieties of health care fraud is perpetrated through medical identity theft. Medical identity theft occurs when someone uses another person's health insurance card or identification with or without her permission to obtain medical services. An insured person commits fraud when he lends his health insurance card to another, who then impersonates the insured in order to receive free care. An uninsured person commits fraud when she impersonates the insured to receive benefits she is not entitled to. Sometimes the imposter has permission from the insured. Other times, the imposter has stolen the insureds insurance information and used it without permission. Each activity is a crime.
Consequences of Health Care Fraud

Health care fraud is not a victimless crime. Medical identity theft can have dire consequences for the individual whose identity is fraudulently used. It sometimes results in erroneous entries on that persons current medical records or the creation of brand new, fictitious medical records in the victims name. For the victim, this may mean that a false medical and financial history that follows them around for years. Imagine failing a physical required for employment due to a disease in your records that does not belong to you, or receiving a co-pay bill for a surgery that you never underwent. These are only a sample of the personal consequences of medical identity theft.

Beyond the personal effects, health care fraud, including medical identity theft, also has a negative impact on the healthcare system as a whole. It is estimated that losses due to fraud add $100 billion to the annual cost of health care in the United States. For most employers, fraud increases the cost of providing benefits to their employees and, therefore, their overall cost of doing business. That translates into higher premiums, taxes, and out-of-pocket expenses as well as reduced benefits and diminished quality of care.
Allowing Others To Use Your Health Care Information Could Lead to Prosecution

Whether you allow someone to use your health care information, or you wrongfully use some elses information, you can be prosecuted for fraud. Health care providers and law enforcement have begun to aggressively pursue those who commit health care fraud. Health care fraud can be prosecuted both civilly and criminally under a variety of statutes and regulations. The nations largest healthcare network, Blue Cross/Blue Shield estimates that they pursued more than 20,000 cases of health care fraud last year, with 606 cases referred to law enforcement agencies. Of the referrals, 206 resulted in criminal convictions (see http://www.bcbs.com/antifraud).

Too many people do not realize the cost to individuals and the health care industry, which are incurred through health care fraud. For this reason many people do not believe health care fraud to be a serious crime. Penalties for health care fraud can be severe. Depending upon which statute an offender is prosecuted under, each count could carry a maximum penalty of 10 years. Fraud resulting in bodily injury to the insured carries a penalty of up to 20 years. If authorities or a private insurer wants to investigate you for health care fraud, you should immediately contact an attorney.