More doctors, insurers asking, ‘Who are you?’

And HIPAA offers little help in resolving disputes. Dixon’s report uses the example of John Doe, who needs to have his appendix removed but discovers that someone who stole his medical identity has already had an appendectomy in his name. The insurance company will reject Doe’s claim, of course, because nobody has two appendectomies.

“For a patient stuck in this type of Catch-22 situation — where no one is willing to or is required to take responsibility for errors that were not the patient’s doing — it may be very difficult for the patient,” the report concludes. “The HIPAA health privacy rule provides no real assistance or remedy. The patient may only be able to ask for the good will, understanding, and cooperation of all concerned.”

Authorities slow to prosecute
Insurance companies are not universally known for their goodwill, so the next step is often legal action. But that can be even more frustrating.

Eleven years after the enactment of HIPAA, only one defendant has ever been brought before a jury, and that didn’t happen until this January, when a Florida man was convicted of conspiracy to defraud the United States, commit computer fraud and aggravated identity theft, and wrongfully disclose private health records.

FREE VIDEO Fighting ID theft On Christmas Day, 2005, “Dateline NBC” told the story of Eric Drew, a cancer patient, critically ill in a hospital bed, who had to track down the man who stole his medical identity. Dateline NBC

The man, Fernando Ferrer Jr., 29, and his cousin, Isis Machado, 23, stole the medical information of more than 1,100 patients of the Cleveland Clinic in Weston, Fla., using it to file false claims for Medicare reimbursement totaling more than $7 million.

It was astonishingly simple, court records reveal. Machado would wait for her supervisor to leave for the day so she could copy patients’ records. She would then drive to a gasoline station, where she would sell the copies to Ferrer for $5 to $10 per patient, she admitted in her plea agreement. Investigators found that as many as 11 different medical and health care providers in Miami later used the Medicare numbers in those records to fraudulently bill the government.

Ferrer faces up to 30 years in prison when he is sentenced in late April with Machado, who pleaded guilty to conspiracy to commit computer fraud and identity theft and faces up to five years.

Organized crime increasingly the culprit
So far, most investigations have snared individuals accused of medical identity theft, but the World Privacy Forum notes a disturbing trend — the increasing involvement of organized crime rings, which have been uncovered in California, New York and Florida.

“In the hands of organized crime, false claims are spread out across multiple patients, and the claim amounts are small,” making them harder to detect but no less damaging to innocent victims or expensive for taxpayers, the report said.

The World Privacy Forum report offers these recommendations:

• Individuals’ rights to correct errors in their medical histories and files need to be expanded to allow them to remove false information from their files.
• Victims of medical identity theft should have the right to receive one free copy of their medical file.
• Individuals should have expanded rights to obtain an accounting of disclosures of health information.
• Notification of medical data breaches to consumers has the potential to save lives, protect health, and prevent losses.
• A National Health Information Network should be established using comprehensive risk assessments focused on preventing medical identity theft while protecting patient privacy.

Until those things happen, medical providers are turning to technology.

Elmhurst and Queens hospitals in Queens, N.Y., for example, have adapted a smart card system that was originally designed to prevent patient confusion. It has issued the cards to thousands of patients, carrying their pictures and coded with abstracts of their medical histories.

Dr. Glenn Martin, Elmhurst Hospital’s director of medical informatics, said the cards merely helped hospital officials ensure that the patient and the history matched, but that could be enough to save millions of dollars.

Lives, too. It may sound simple, Martin said, but the smart cards do help sniff out the cases in which “suddenly you developed the disease of an 80-year-old when you’re actually a 20-year-old female.”

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