Most of the time when we discuss identity theft in healthcare, it's in regard to patients' identities stolen by imposters who want to use their insurance. In a medical practice, physicians' identities, especially their credentialing numbers such as their National Provider Identifier (NPI), also are vulnerable to fraud.
A physician's NPI is incredibly easy for thieves to access if they're looking for it, Pam Dixon, founder of the World Privacy Forum, recently told Healthcare Finance News.
Anne Peters, an internist practicing in southern California, is just one example of a physician whose NPI was stolen and used to bill Medicare for procedures she never performed. And although Peters informed the Centers for Medicare & Medicaid Services (CMS) that she'd been the victim of fraud, the agency prosecuted her for grand theft for the $650,000 to $700,000 Medicare had paid out in others' fraudulent claims, cut off her Medicare payments and demanded back payment, according to the article. The IRS also pursued her for taxes owed on the Medicare payments. Although Peters eventually cleared her name, the ordeal cost her an enormous financial and emotional toll.
As of late, the government has made some progress in cracking down on Medicare fraud. For instance, FierceHealthcare reported that the government is applying tougher penalties for healthcare fraud, with criminals facing 20 to 50 percent longer sentences for crimes involving more than $1 million in losses. The effort also includes outreach to physician about protecting their identities, HFN reported.
To combat theft before it occurs, Shantanu Agrawal, M.D., the medical director at CMS' Center for Program Integrity, recommends that physicians regularly check billing addresses and services associated with identifiers and communicate with office and compliance staff about how to securely handle identifiers.
To learn more:
- read the article from Healthcare Finance News