WRAL Investigates

Medical ID theft up in down economy

Posted September 21, 2009
Updated September 22, 2009

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— A growing number of medical practices across the Triangle are asking patients for a photo identification card in addition to their insurance card when they show up for appointments.

Officials say a dramatic spike in medical identity fraud cases is a main reason behind the change in practice.

Medical paperwork Photo ID now needed at many doctor's offices

"We've gone from perhaps a handful a year to one or two a week. That's significant," said Roger Purnell, director of the Special Investigations Unit for Blue Cross Blue Shield of North Carolina.

ID theft, fraud and other illegal activity costs health insurers, providers and ultimately patients an estimated $68 billion a year.

Purnell attributed the rise in ID theft to the down economy, with more uninsured people looking for cheap care.

Offenders often steal personal numbers of insured people or make up names. Stephen Thomas Mullen of Knightdale, for example, was recently arrested after WakeMed accused him of giving a fake name and address and running up a $45,000 medical bill.

Guidelines at WakeMed also call for patients to provide photo IDs, and officials said hospital staff work to confirm patients are who they say they are.

"Over the last few years, this has definitely gotten more attention," said Becky Andrews, WakeMed's vice president for financial services. "We're always looking for new ways to positively identify patients."

In other instances, patients are complicit in the fraud by loaning their insurance cards to others.

Purnell cited one case where a man took his girlfriend to the emergency room and tried to pass her off as his wife by using his insurance card. The fraud was eventually exposed.

"It's extremely serious," Purnell said of the growing amount of fraud. "Everyone suffers. Costs are being incurred that are inappropriate."

Medical professionals said those who can't afford care are better off telling the truth.

By law, emergency rooms can't turn away the sick and injured when they don't have identification or insurance. Patients who lie about their identity also face the potential for medical complications.

"We have all (of a patient's) medications and chart all their allergies and these kinds of things," said Kristin Fisher, administrator of Raleigh Family Practice. "(If) a different patient presents (and) says they're this patient with this insurance, they could cause a lot of safety issues."

Insurers and health care providers said patients need to be more vigilant to stop medical ID theft by routinely checking their medical files and bills for any unusual charges or prescriptions.

13 Comments

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  • shoppingqueen Sep 23, 2009

    can you really say a healthcare plan that your own President will not even say his family and his Cabinet members and there families are going to be using is going be so much better.

  • shoppingqueen Sep 23, 2009

    Citizen782 – so lets see I pay $65.00 a month for a family of 4 (kids are 8 & 4), and we get 8 cleanings a year which are included (no copays) and I have 80% Coverage on Basic Restorative and 50% Coverage on Major Restorative (Including Orthodontics) with a $25 Individual or $75 Family deductible. Do I seem CRAZY to ELECT to carry dental insurance through my employee sponsored plan? My mommy doesn’t seem to think so. Plus it’s a whole lot easier for my company to take that $32.50 out my check before taxes than it is for me to write a big check at the dentist office 8 or more times a year.

    But how can you say that person at the grocery store talking on their Blackberry in their design clothes buying steaks using their EBT card and then complaining I can’t afford insurance doesn’t need a lecture about priorities? Stop acting like your opinion is the right one. Because if you actually read what nanasix, dlb800 and I were saying - the system is broken and needs to be fixed, but

  • WRALblows Sep 22, 2009

    "That the insurance companies are allowed to get away with murdering people to support their profits is even worse."

    And here a perfect explanation of the problem. No one has ever told me why I'm suppose to care that legislation could get passed that ruins private health insurers. I promise I've paid more into their profitability than I'll ever get back. And I can also promise that the minute I stop being profitable to them is the minute they deny claims and cancel coverage. It's simply an evil enterprise that only evil or naive people could want to keep intact.

    I want to hear more about how great private insurance companies are and how delighted we should all be to have them making record profits off us. Please, explain to me how this "free market" product is providing health care better than the government or another for profit entity could... because it seems to me, they suck at it.

  • WRALblows Sep 22, 2009

    "What is amazing is that people that think they are entitled to have the Government rob someone for their personal benefit"

    It's called taking care of each other for the greater good. Oh wait, "selfish" Neocon's call that socialism...

  • WRALblows Sep 22, 2009

    I have a 1988 Ford Ranger pickup I need to sell for the price of a 2010 Cadillac. A few of you need to move to the front of the line to make the purchase since you obviously know a good deal when you see it.

    Let me translate for the ones with the fog between the ears. This has almost NOTHING to do with "responsibility" or "priorities". It has everything to do with value for the dollar. I ELECT not to carry dental insurance through my employee sponsored plan because it's a BAD DEAL. I spent less out of pocket for cleanings and a root canal and implant in 2008, out of pocket, than I would have on the annual premium alone (not including co-pays, co-insurance etc.)

    You have to do the math and the a lot of the time form many people private, or even employee sponsored health care can be a BAD INVESTMENT. Especially for someone that's relatively healthy.

    Now, lecture some more about priorities and what your mommy told you. And quit pretending the current system is not very broken.

  • shoppingqueen Sep 22, 2009

    I completely agree with both nanasix and dlb800. Especially you dlb800 people to do not put their priorities in the right order. People do you realize that in Canada yes they have universal healthcare, however if they need a liver transplant the government reviews the persons background and then decides if they deserve to have the transplant or not. Yes I am aware we do that to a point however we just see where you need to be placed on the transplant listed not if you should get a one or not. WOW that sounds great sign me up – let’s see how many poor people are worthy and how many rich people we can save. I have worked since I was 14 ½ and when I got out of school and started working fulltime I started carrying insurance on myself. I know that insurance is expensive but my parents have always told me it’s important and I have to have it, so it just blows my mind that so many don’t carry it.

  • dlb800 Sep 22, 2009

    I'm sorry, but how can I have sympathy for idiots? Excuse me, but if you can't afford health insurance, then why do you have a cell phone? Why do you have cable TV? Why do you take vacations? Why do you have 6 kids?

    How can I have sympathy if you don't take responsibility for your own actions and decisions?

    If you can't afford to raise a child, then why are you having one? What? Can't afford birth control? That's a whole lot cheaper than raising a child.

    You have to draw the line somewhere.

  • nanasix Sep 22, 2009

    This is just another criminal act, and those committing this fraud should be punished to the max. I'm not for gov't run health care, but feel the government should be doing something about the real problems, i.e., medicare and medicaid, and fix the problems. If they want to regulate something, then let them take on the insurance companies that make billions of dollars in profits every year. Establish rates that all americans can afford, and set regulations that require them to insure everyone, and let the "People" make the decision as to who they have their insurance coverage with. Stop giving medical treatment to "Illegals", maybe they'll go back to their home countries, and it would sure leave a lot less cases to be investigated. Investigate the fraud in all aspects of medical care, i.e., the Middle Easterner's in the Raleigh area that defrauded Medicare out of 13 million dollars. They can't be the only cell doing this in our country.

  • whatelseisnew Sep 22, 2009

    "Wait until you are seriously ill then you can judge on what some people have to do to get healthcare in this supposedly civilised country."

    And this is the typical selfish attitude. What is amazing is that people that think they are entitled to have the Government rob someone for their personal benefit, just do not see how selfish they are being. The other sad part is the foolish belief that more Government intrusion will lower the costs. It will raise costs, thus causing more and more Government theft of people's property and liberty.

  • moth Sep 22, 2009

    That people are now forced to steal in order to get medical care is absolutely shameful.That the insurance companies are allowed to get away with murdering people to support their profits is even worse.

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