Warning Signs You May Be a Physician Identity Theft Victim

May 31, 2012

The earlier you recognize you are a victim of identity theft the better. Here are key warning signs to watch out for.

Physician identity theft holds great consequences for physicians, from compromised patient health as a result of a fraudster altering patient records to financial loss due to taxes on earnings the physician never received.

If a physician recognizes that his physician identity has been stolen sooner rather than later, he can - hopefully - minimize those consequences.

“The negative outcomes of identity theft really build over time,” emergency physician Shantanu Agrawal, medical director at CMS’ Center for Program Integrity, which focuses on fraud and abuse issues, told Physicians Practice. The longer a physician is unaware that his identity is stolen, for instance, the longer a fraudster can rack up fake bills in the physician’s name.

According to an article cowritten by Agrawal and appearing in the Journal of the American Medical Association, Federal Trade Commission data shows that 32 percent of identity thefts are discovered more than one year after they occur.

Here are some ways to ensure that if your identity is stolen, you can catch on as soon as possible:

Check in: One way to prevent physician identity theft is to update payers regarding any enrollment changes, such as if you close your practice or switch locations. Naturally, one way to recognize quickly that you are a victim of physician identity theft is to monitor those enrollment records closely.

For instance, if you’re treating Medicare patients, visit the Medicare Provider Enrollment, Chain, and Ownership Systems (PECOS) website several times a year to view your record and make sure none of the information is incorrect, said Agrawal.

Watch and monitor: Thoroughly monitor your billing and compliance processes and look closely at remittance notices from payers. That way if there’s a discrepancy, you’ll notice it quickly. “Make sure you understand what the activity is - what the credits and debits are coming into and leaving your account,” said Agrawal.

Listen closely: Pay attention if a patient calls your practice and inquires about a bill because, for instance, it contains an explanation of benefits that does not seem right. It could indicate that a fraudster is using your information to bill for a service never rendered to that patient, Linda Vincent, a nurse and private investigator, told Physicians Practice.

“That’s usually one of those red flags when the patient calls or asks about a date that they were never seen on or remember being seen,” said Vincent, who is also founder of The Identity Advocate, which provides education, consulting, and resources to help prevent identity theft.

Along the same lines, ask patients to keep an eye out for discrepancies in billings and benefits statements, said Agrawal. “That kind of information can be really key, and we’ve seen numerous cases where it was really the patients that brought the identity theft to light,” he said.

Monitor credit reports: Vincent recommends checking your personal and business credit reports at least every quarter and looking at reports from the different credit reporting agencies each time you check.

That’s because if your physician identity is stolen, there might also be a connection to your personal identity, said Vincent. “This is an insidious business where you never [know] the where or how someone gets your identity ...”

Risk factors: Keep in mind that all physicians are equally at risk of identity theft, regardless of your particular specialty or practice setting (for example, if you are in a rural or urban location), Agrawal said.

Though some “fraud hotspots” exist - such as Miami, Los Angeles, and New York - that doesn’t necessarily mean identity theft happens to physicians in these locations more often.

For instance, while the identity theft activity might occur more often in Los Angeles, data shows that stolen identities tend to be from individuals located throughout the country.

This is the third part of a weekly series on medical identity theft. Next week’s blog posting will delve into what to do as soon when you realize your identity has been stolen.