Medical identity theft: when someone else uses your health coverage

Medical identity theft happens when someone uses your name, insurance ID, or Medicare number to get health care, prescriptions, or medical equipment, or to file fraudulent claims. Beyond the financial hit — drained benefits, surprise bills, blown-through coverage limits — it carries a danger the money-focused scams don't: false information can end up in your medical record, so another person's blood type, allergies, diagnoses, or medications could be attached to your file. It's harder to detect than credit fraud because most people never read their medical statements the way they read a bank statement.

How it happens

• A stolen or bought insurance/Medicare ID is used at clinics, pharmacies, or equipment suppliers to bill your coverage.
• Data breaches at hospitals, insurers, or providers leak the identifiers needed to impersonate you medically.
• 'Free' equipment, genetic-test, or screening scams harvest your insurance number, then bill for services in your name.
• Sometimes a family member or acquaintance without insurance uses yours to get care.

The warning signs in the paperwork

1. An Explanation of Benefits (EOB) lists a service, provider, or date you don't recognize.
2. A bill or collection notice arrives for care you never received.
3. Your health plan says you've reached a benefit limit you never used.
4. A denied claim cites a condition you don't have, or your records mention treatments that aren't yours.
5. A provider's records show a prescription or diagnosis you didn't get.

What to do

• Guard your insurance and Medicare numbers like your SSN; never give them to unsolicited callers or 'free' offer booths.
• Review every EOB and medical bill, and question anything unfamiliar with the provider and your insurer.
• Request copies of your medical records and an 'accounting of disclosures' to check for entries and treatments that aren't yours.
• Report to your insurer's fraud line, the provider, and reportfraud.ftc.gov; for Medicare, call 1-800-MEDICARE.
• Ask providers and insurers to correct false information in your records in writing, and follow up — corrupted records can persist.

The bottom line

Medical identity theft is doubly dangerous: it spends your benefits and it can poison your medical record with someone else's health data. Because it hides in paperwork most people never read, the single best habit is treating every Explanation of Benefits like a bank statement and questioning anything you don't recognize. Guard your insurance IDs, audit the statements, and push to correct your records if something's wrong. This is general information, not medical or legal advice; work with your insurer and providers on specifics.