Partners in crime: Medical identity theft and fraudulent billing

Healthcare-related identity theft is on the rise, accounting for 43 percent of all identity thefts reported nationally in 2013, according to a report by the Identity Theft Resource Center, Kaiser Health News reported. 

These events exposed more than four million records in 267 data breaches. Medical identity theft spikes are a bad omen for program integrity, because when criminals get their hands on other people's health insurance identification numbers, it's just a matter of time before insurers receive false claims.     

Three healthcare fraud cases make this point:     

  • An Ohio woman working in a dental office accessed Medicaid beneficiaries' protected information and used it to obtain desired prescription drugs illegally, KHN noted.
  • A Massachusetts psychiatrist used false diagnoses of drug addiction and depression for people who weren't his patients to claim payment for services never rendered. One victim of the scheme discovered the false diagnoses when he applied for employment; the pyschiatrist never treated him, KHN reported.
  • And Luis Duluc, owner of a Florida rehabilitation center, conned Medicare out of millions after using ill-gained patient and provider information to claim payment for physical therapy neither ordered nor provided, news-press reported. Duluc and his associates formed a ring of other clinics and filed claims for them in exchange for kickbacks on subsequent Medicare payments, according to the article. Duluc pled guilty in federal court last week to conspiracy to commit healthcare fraud and making a false statement relating to healthcare matters. He faces up to 15 years in prison.

Medical identity theft-related cases may have contributed to a record-setting year for the Medicare Strike Force. The force, which led the Duluc investigation, filed 137 cases, charged 345 people, and obtained 234 guilty pleas and 46 convictions in fiscal 2013, as FierceHealthPayer reported. Similarly productive, the U.S. Justice Department recouped $3.8 billion through civil cases involving fraud committed against the government in the fiscal year ending last September, with $2.6 billion in healthcare fraud recoveries.

For more:
- here's the KHN article
- read the news-press article

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