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Identity Theft With Health Insurance: What You Need to Know

You likely do almost everything online, including things related to your health. Medical services and insurance are more digital than ever.

If you're trying to get quotes or enroll in a health plan online, you'll send private medical information over the internet. Unfortunately, this process could put your most intimate details at risk.

Identity theft is a rampant problem, including in the insurance industry. Learn about medical identity theft risks and how to protect your information.

What Is Medical Identity Theft?

Medical identity theft occurs when someone steals information related to your health care or insurance details. They typically access this information through electronic medical records and insurance files. These records may include what you share to enroll in a health insurance plan online.

Thieves may uncover your personally identifiable information (PPI), including your:

  • Full name
  • Social Security number
  • Medicare number
  • Insurance card or ID number
  • Treatment or other medical history
  • Credit card or bank account numbers
  • Phone number and other contact information
  • Home address

Often, the thief uses these details to get health care or buy prescription drugs. Or, they might submit fake Medicare billings in the victim's name to get reimbursements.

How Common Is Health Insurance Identity Theft?

It is unclear how often identity thieves and scammers steal medical information. Statistics on the frequency of medical identity theft are rare because this crime can be hard to detect. It is also often misreported as general health care fraud.

In 2022, the Federal Trade Commission (FTC) received 27,820 reported cases of medical identity theft. In 2023, the U.S. Department of Health and Human Services tracked over 700 major health care data breaches that exposed millions of patient records. As far back as 2006, a report prepared for the government estimated that 250,000 Americans were already victims of medical identity theft.

These statistics suggest that medical identity theft is a growing problem. Your risk may be higher than you'd think.

Identity Theft on the ACA Health Insurance Marketplace

Your data may be vulnerable on any website, no matter how legitimate it is. Recent history has shown that even applying for government-sponsored insurance coverage can put you at risk.

In late 2013, the federal government launched its online health insurance exchange. This official website was the only way for the public to sign up for benefits under the Affordable Care Act (ACA), also known as Obamacare.

Unfortunately, the initial rollout of the ACA Health Insurance Marketplace became the subject of criticism for user data risks. Insurers have a legal duty to protect patients' information, but cybersecurity flaws with online systems leave the door open to hackers. Other state and regional exchanges are also susceptible to privacy issues. As recently as 2023, a data breach of the District of Columbia exchange (DC Health Link) affected more than 170,000 people.

You can check the privacy policy to understand how Healthcare.gov will use your information. Regardless, watch out for signs that someone is trying to get health care services or file claims in your name.

How To Know If Someone Stole Your Identity

Some of the unique red flags for medical identity theft include:

  • Bills in your name for medical care you never received
  • Calls or documents from a medical provider about an unfamiliar procedure or treatment
  • Rejection of your prescription medication at the pharmacy
  • Denial of insurance coverage due to a new condition you don't have
  • Criminal accusations of illegal medical or insurance fraud that you didn't commit

You might also spot the other signs of identity theft, such as finding unrecognizable debt in your credit report.

Protect Yourself Against Medical Identity Theft

Any time you give your personal information online, identity theft is a risk. Medical and insurance data is valuable to thieves. It often has more details about your life than something like your credit card number.

You must rely on the business or exchange's web security if you need health coverage. As a user, you can't stop a large-scale data leak. Yet, some forms of identity theft involve tricking you into giving your details directly to the thief.

Enrollees can take steps to reduce risk and avoid scams, such as:

  • Look for government web or email addresses (ending in ".gov") when providing any personal medical information online
  • Never give personal health information, including medical or treatment history, to anyone who claims to be associated with the government or with Obamacare
  • Store any paper records in a safe or deposit box
  • Contact your state's department of health or consumer protection agency to verify that an exchange, insurance company, or health care provider is genuine
  • Be wary of pressure to sign up for other services or programs, such as getting a new Medicare or Medicaid card
  • Ignore offers to help you enroll in ACA coverage for a fee (it is illegal for legitimate navigators to charge you for this service)
  • Check your credit report, medical records, and insurance records regularly to spot potential problems

If you get a suspicious call or message, you can contact Healthcare.Gov to check that your identity is safe. You can also report fraud attempts to the FTC, which investigates medical identity theft to protect consumers.

Getting Legal Help with Identity Theft

Health care privacy laws give you essential rights. If you believe an insurer or someone else exposed your personal information, you can talk to a consumer protection lawyer. They can help you evaluate your recovery for the damage you suffered from a stolen identity.

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Next Steps

Contact a qualified consumer attorney to assist with the hazards and stress accompanying identity theft and online scams.

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