Medical Identity Theft
The FTC received 1.4 million identity theft reports in 2024.
Quick Answer
Medical identity theft occurs when a scammer uses your personal information to obtain healthcare services, prescription drugs, or submit fraudulent insurance claims, costing victims an average of $13,500 to resolve.
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How It Works
1
A criminal steals your personal information, such as your name, Social Security number, or health insurance number. This can happen through data breaches of healthcare systems, phishing emails, or physical theft of documents.
2
The thief uses your identity to receive medical treatment, get prescription drugs, or purchase medical equipment. They may also file fraudulent claims with your insurance provider to receive payments.
3
The fraudulent activity creates false entries in your medical records, which can lead to misdiagnosis or incorrect treatment in a future medical emergency. The victim is left with the bills for services they never received, which can damage their credit score if sent to collections.
Red Flags
- Receiving a bill for medical services or equipment you never received.
- Notices from your health plan that you have reached your benefit limit unexpectedly.
- Calls from debt collectors about a medical debt you do not owe.
- Finding incorrect information or unfamiliar diagnoses in your medical records.
- Being denied insurance coverage because your records show a condition you don't have.
- Seeing a medical debt collection on your credit report that you don't recognize.
What to Do If Targeted
- Request and review copies of your medical records from every provider where the thief may have used your information. Report any errors in writing and ask for them to be corrected.
- Get copies of your Explanation of Benefits (EOB) statements from your health insurer. Report any fraudulent charges to your insurer's fraud department.
- File an identity theft report with the Federal Trade Commission at IdentityTheft.gov. This will provide you with a personalized recovery plan.
- Place a fraud alert or credit freeze with the three major credit bureaus (Equifax, Experian, TransUnion) to prevent new accounts from being opened in your name.
- File a report with your local police department. This can be helpful in resolving disputes with providers and insurance companies.
- Regularly monitor your credit reports for any unfamiliar medical collection accounts.
How to Report It
- FTC — Report identity theft to the Federal Trade Commission and get a personalized recovery plan.
- FBI IC3 — Report cyber-enabled health care fraud schemes to the FBI's Internet Crime Complaint Center.
- HHS OIG — Report fraud, waste, or abuse involving U.S. Department of Health & Human Services programs like Medicare.
- FCC — File a complaint about phone scams, robocalls, or unwanted calls with the Federal Communications Commission.
- AARP Fraud Helpline — Call 877-908-3360 for free support from trained fraud specialists. Available to anyone, not just AARP members.
- FTC — File a fraud report with the Federal Trade Commission.
Key Statistics
- The average out-of-pocket cost for a victim of medical identity theft is $13,500. — Ponemon Institute
- The Federal Trade Commission (FTC) received 27,820 reports of identity theft related to medical services in 2022. — FTC Consumer Sentinel Network
- A complete medical record can be sold for up to $1,000 on the dark web, whereas a Social Security number may sell for only $1. — Experian
- In 2023, the healthcare industry experienced 809 data compromises, the highest of any sector. — Identity Theft Resource Center 2024 Data Breach Report
- Medicare and Medicaid fraud costs U.S. taxpayers more than $100 billion a year. — CNBC
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Frequently Asked Questions
Medical identity theft is when someone steals and uses your personal information, like your name or health insurance number, to get medical care, prescriptions, or file fake insurance claims. This can damage your medical records and financial health. Victims often face an average cost of $13,500 to resolve the issues caused by this crime. (Ponemon Institute)
This crime is dangerous because it can corrupt your personal medical records. An imposter's health information, such as their blood type or allergies, can be added to your file. In an emergency, this false information could lead to a misdiagnosis, improper treatment, or a life-threatening medical error. (NCDOJ)
Yes, medical identity theft can negatively impact your credit score. If a thief uses your identity to get medical services and doesn't pay the bills, those unpaid debts can be sent to collection agencies. These collection accounts can then appear on your credit report and lower your score. (Equifax)
Your protected health information (PHI) is highly valuable to criminals and can be sold for up to $1,000 per record on the dark web. Thieves use this data to commit insurance fraud, get free medical care, and obtain prescription drugs for illegal resale. For comparison, a Social Security number sells for as little as $1. (Experian)
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