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

01.06.13 written by

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.