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What Is Physician Medical Identity Theft? MD News Magazine, Nov/Dec. 2012

Krugliak, Wilkins, Griffiths & Dougherty Co., L.P.A.

Medical identity theft is the fastest-growing type of identity theft. It can involve the theft of a patient’s health information or the theft of a physician’s professional identifiers. Although physicians are implicated by both types, the latter can create substantial professional and financial harm for physicians. In fact, a Ponemon Institute survey estimated that resolving medical identity theft on average takes more than one (1) year and costs more than $22,000.

Physician identity theft arises when a physician’s professional identifiers are used either to bill for services that are not actually provided or to order fraudulent prescriptions or medical devices. A major contributor to physician medical identity theft is the widespread availability of physicians’ professional identifiers, which are publically available on the National Provider Identifier (“NPI”) registry website. A basic search for a physician reveals the physician’s NPI number, license number, licensing state, and taxonomy.

Until physicians’ professional identifiers are preserved as confidential, risk averse physicians should take steps to protect their identity. Physicians should consider: (1) educating patients on the importance of reviewing Medicare summary notices and the explanations of benefits; (2) confirming the accuracy and currency of the information contained on the NPI registry website; and (3) verifying and updating their enrollment information at the Provider Enrollment, Chain and Ownership System website.

Note:  This general summary of the law should not be used to solve individual problems since slight changes in the fact situation may require a material variance in the applicable legal advice.

T.J. Evans is an attorney with Krugliak, Wilkins, Griffiths & Dougherty Co., L.P.A.

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