Medical identity theft occurs when a beneficiary’s Medicare number is misused, either by a provider, a supplier, or by someone posing as the real beneficiary in order to receive medical care. Such Medicare numbers are considered “compromised.” Medicare numbers are for life, even if stolen or misused, so a beneficiary whose number is compromised may be affected forever by false claims against his or her Medicare number.

Health Impact

Receiving health care from a fraudulent provider can mean the quality of the care is poor, the intervention is not medically necessary, or worse: The intervention is actually harmful. A beneficiary may later receive improper medical treatment from legitimate providers as a result of inaccurate medical records that contain:

  • False diagnoses
  • Records showing treatments that never occurred
  • Misinformation about allergies
  • Incorrect lab results

Additionally, because of inaccurate or fraudulent claims to Medicare, beneficiaries may be denied needed Medicare benefits. For example, some services have limits. If Medicare thinks such services were already provided, they will deny payment.

Report Suspected Fraud

To report suspected fraud, click here.

Source: SMP Resource Center