Preventing Health Care Fraud and Identity Theft

If you are concerned about identity theft, the Frequently Asked Questions in the following sections may answer some of your questions about protecting your identity:

For more information, see Identity and Medical Identity Theft Resources.

The Community Health Plan Identity Theft Policies and Procedures are also available.

SEE ALSO

To get any of the following information, click the links below or contact the Customer Service team and ask us to send it to you:

How Can I Help Stop Health Care Fraud?

Health care fraud takes money from health care programs and leaves less money for real medical care.

Here are some ways you can help stop fraud:

  • Give your Community Health Plan ID card or your ID number only to a health care provider, a clinic, or a hospital.
  • Give your ID only when you are getting care.
  • Never let anyone borrow your Community Health Plan ID card.
  • Never sign a blank insurance form.
  • Always be ready to show picture ID when checking in for a medical appointment.
  • Be careful about giving out your Social Security number.

About Medical Identity Theft and Health Information Breaches

Q. What is medical identity theft?

A. Medical identity theft is when someone:

  • Uses a person's name and sometimes other personal information—such as insurance information—without the person's knowledge or consent to obtain medical services or goods, or
  • Uses the person's identity information to make false claims for health care services or goods.

Medical identity theft often results in wrong information being put into medical records and can result in the creation of fake medical records in the victim's name.

Q. What are the dangers of medical identity theft?

A. The most serious problem faced by victims is having someone else’s health information in their medical record or health insurance records. To provide safe health care treatment, a health care provider needs correct health information for the individual being treated. A common problem faced by victims of medical identity theft is that they are charged for health care services that they did not get.

Q. How do I know if I am a victim of medical identity theft?

A. There are several ways you can tell that you may be a victim.

Explanation of Benefits. One way to know if you are a victim of identity theft is to look at any Explanation of Benefits sent by Community Health Plan or another insurance company.

An Explanation of Benefits is a list of the health care services provided under your health plan account number. It is sent to you after you get or a family member gets health care services, if you are responsible for any cost sharing. If you do not get an Explanation of Benefits after going to the doctor, you may want to call your insurance company.

Look for the following risks in your Explanation of Benefits and your medical records:

  • Office visits you did not make.
  • Health care services you did not get.
  • Medical equipment you did not buy or get.
  • Health information such as health care problems you do not have and medicines you do not take.

HIPAA Rights—Know if You're a Victim. Another way to know if you are a victim of identity theft is to use your rights under the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a federal law that protects health records and medical privacy.

There are two rights under HIPAA you can use to figure out if you are a victim of medical identity theft (you can get forms online to request information):

  • Right to Access. The right to see or get a copy of your medical records from your health care provider and/or health insurance company.
  • Right to an Accounting of Disclosures. The right to get a list of the times your health care providers or health insurance company shared your personal information with another person or organization.

Q. How can I protect myself if I am a victim of medical identity theft?

A. There are several ways to protect yourself if you are a victim.

HIPAA Rights—Protect Yourself. One way to protect yourself after becoming a victim of medical identity theft is to use your rights under the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a federal law that protects health records and medical privacy.

There are three rights under HIPAA you can use to protect yourself (you can get forms online to request information, www.chpw.org):

  • Right to Access. The right to see or get a copy of your medical records from your health care providers and health insurance company.
  • Right to an Accounting of Disclosures. The right to get a list of the times your health care provider or health insurance company shared your personal information with another person or organization.
  • Right to Correct PHI (personal health information). The right to request a correction of your health records held by your health care providers and health insurance company.

If you find wrong information in the records you requested from your health care providers or from your health insurance company, you will want to ask them to correct the information in your file.

Change Personal Identification Numbers. If you suspect that you are a victim of medical identity theft, you may want to tell your health insurance company and medical providers to change your member or patient identification numbers.

File a Police Report. You may also want to file a police report and keep a copy of the report for your records. A police report is very helpful when you are working with health care providers, health insurance companies, and creditors to correct your health records and credit file.

Online Resources:

About Identity Theft and Breach of Financial Information or Social Security Numbers

Q. My personal information was involved in a breach. How do I know if my personal information has been used by someone else?

A. One way to find out is to order your credit reports from the three credit bureaus: Equifax, Experian, and Trans Union. If you see accounts on your credit report that you did not open or applications for credit ("inquiries") that you did not make, these could be signs that someone else is using your personal information without your permission.

Q. Do I have to pay to run a credit report?

A. No. You can order free credit reports from all three credit bureaus once a year. You can do this online at www.annualcreditreport.com or by phone at 1-877-322-8228.

Q. How long does it take to get my credit report?

A. You can view your reports online if you order them at www.annualcreditreport.com. If you order by phone, reports will be mailed within 15 days.

Q. What should I look for on my credit report?

A. Look for any accounts that you did not open, especially accounts opened recently. Look at the inquiries or requests section for names of creditors from whom you haven't requested credit.

Note that some kinds of inquiries, labeled something like "promotional inquiries," are for offers of credit you did not ask for, mostly from companies with whom you do business. Don't be concerned about those inquiries as a sign of fraud. You are automatically removed from lists to receive unsolicited pre-approved credit offers when you put a fraud alert on your account. You can also stop those offers by calling 888-5OPTOUT.

Look in the personal information section for addresses where you've never lived.

Any of these things might be indications of fraud. Also be on the alert for other possible signs of identity theft, such as calls from creditors or debt collectors about bills that you don't recognize, or unusual charges on your credit card bills.

Q. How often should I order new credit reports and how long should I go on ordering them?

A. It might be a good idea to order copies of your credit reports every three months for a while. How long you keep ordering them is up to you. Identity thieves usually, but not always, act soon after stealing personal information. You might want to check your credit reports at least twice a year to protect yourself.

Q. Why can't I talk to someone at the credit bureaus?

A. First, you must order your credit reports. When you get your reports, each one will have a phone number you can call to speak with a live person in the credit bureau's fraud unit. If you see anything on any of your reports that looks wrong or that you don't understand, call the number on the report.

Fraud Alerts and Breaches of Financial Information or Social Security Numbers

Q. What else can I do to protect myself from breaches of financial information or social security numbers?

A. You can put a fraud alert on your credit files. Call any one of the three credit bureaus at the numbers below and follow the "fraud victim" instructions:

  • Trans Union 1-800-680-7289
  • Experian 1-888-397-3742
  • Equifax 1-800-525-6285

The one you call will notify the other credit bureaus to place the alert. When you call the credit bureau fraud line, you will be asked for identifying information and will get the opportunity to enter a phone number for creditors to call. You may want to make this your cell phone number.

Q. I called the credit bureau fraud line and they asked for my Social Security number. Is it okay to give it?

A. The credit bureaus ask for your Social Security number and other information to identify you and to avoid sending your credit report to the wrong person. If you want the credit report you must give this information to the credit bureau that you call.

Q. Do I have to call all three credit bureaus to place a fraud alert?

A. No. If you call just one of the bureaus, they will tell the other two. A fraud alert will be placed on your file with all three and you will get a letter from all three saying that they put a fraud alert on your account.

Q. What is a fraud alert?

A. A fraud alert is a message that credit issuers get when someone applies for new credit in your name. The message tells creditors that there is possible fraud associated with the account. They must take steps to verify the identity of the applicant. For example, they may call you at the phone number you gave when placing the fraud alert.

Q. Will a fraud alert stop me from using my credit cards?

A. No. A fraud alert will not stop you from using your existing credit cards or other accounts. It may slow down your ability to get new credit. Its purpose is to help protect you against an identity thief trying to open credit accounts in your name. Credit issuers get a special message alerting them to the possibility of fraud. Creditors know that they should re-verify the identity of the person applying for credit.

Q. How long does a fraud alert last?

A. An initial fraud alert lasts 90 days. You can remove an alert by calling the credit bureaus at the phone number given on your credit report. If you want to place a fraud alert for a second time, you can do so.

Q. What if I have a fraud alert on, but I want to apply for credit?

A. You should still be able to get credit. While a fraud alert may slow down the application process, you can prove your identity to a creditor by providing identifying information.

Q. I heard that I could "freeze" my credit files. How does that work?

A. A security freeze is a stronger measure than a fraud alert. A freeze prevents others from seeing your credit history without your permission. It is the strongest protection available against identity thieves opening new accounts in your name.

Identity theft victims with a valid police report and adults ages 65 and older are able to place a freeze for free. Other individuals must pay a fee of $10 to place a freeze with each of the three credit bureaus for a total cost of $30. You can also temporarily lift the freeze for $10, if you want to apply for new credit yourself.

For more information about the freeze, see the Credit Freeze and Fraud Alert page of the Washington State Attorney General's Office website (www.atg.wa.gov/freeze.aspx) or call the Consumer Issues division of the Attorney General's Office at:

  • 1-800-551-4636 (in-state only)
  • 1-206-464-6684 (out-of-state callers)
  • 1-800-833-6384 (for the hearing impaired)

Call centers are open Monday through Friday, 10:00 am to 3:00 pm.

About Your Social Security Number

Q. Should I contact the Social Security Administration and change my Social Security number (SSN)?

A. The Social Security Administration very rarely changes a person’s SSN. Possible fraud based on the use of your SSN would probably not be a reason for which the Social Security Administration would change your SSN.

In most cases, getting a new SSN would not be a good idea. There are drawbacks to getting a new social security number. A new social security number would not have a credit history. No credit history would make it difficult for you to get new credit, continue college, rent an apartment, open a bank account, get health insurance, etc.

To protect your privacy, you should limit the use of your SSN where it's not required. For example, if your bank account number or PIN is your SSN, you should ask the bank to give you a different number. Do NOT use last four digits of your SSN, your mother's maiden name, or your birth date as a password for financial transactions.

Closing Personal Accounts

Q. Should I close my bank account?

A. If your bank account number was among the items of personal information compromised in the breach, you may wish to close it.

Q. Should I close my credit card or other accounts?

A. Closing your account will help protect you, if your account number was among the items of personal information included in the breach.

As a general privacy protection measure, you should always look over your credit card bills carefully to see if there are any purchases you didn’t make. If so, contact the card company immediately.

Identity Theft of Minors and the Deceased

Q. I think my child, who is a minor, may be a victim of identity theft. What should I do?

A. You may want to contact the three credit bureaus and explain that you believe your child is a victim of identity theft. The three credit bureaus do not knowingly keep credit files on minors.

You can also contact the Washington State Attorney General's Office for help at:

  • 1-800-551-4636 (in-state only)
  • 1-206-464-6684 (out-of-state callers)
  • 1-800-833-6384 (for the hearing impaired)

Q. I think my spouse, who is deceased, might be a victim of identity theft. What should I do?

A. You may want to contact the three credit bureaus and explain that you believe your deceased spouse is a victim of identity theft.

You can also contact the Washington State Attorney General's Office for help at:

  • 1-800-551-4636 (in-state only)
  • 1-206-464-6684 (out-of-state callers)
  • 1-800-833-6384 (for the hearing impaired)

Q. What else can I do to protect myself?

A. If you find out that you have been a victim of identify theft, you should tell the police right away, contact any creditors involved, and tell the credit bureaus.

For more information about what to do, see:

Notifying Law Enforcement of Identity or Medical Identity Theft

To notify law enforcement:

  • Make a report to your local sheriff or police department. Make sure to ask for and keep a copy of the police report for your records.
  • Report it to the Federal Trade Commission's Identity Theft Hotline: 1-877-IDTHEFT (438 4338).

Identity and Medical Identity Theft Resources

World Privacy Forum website. Information about how to prevent and recover from medical identity theft.

Identity Theft Resource Center website. Example letters available for download that victims can use with creditors, medical providers, health plans, etc.

Federal Trade Commission Identity Theft Division website. Information about how to prevent and recover from identity theft.

Washington State Office of the Attorney General:

  • Consumer Resource Center: 1-800-551-4636. Refers victims to the proper authorities, assists victims with referrals, and helps resolve problems with credit reporting and collections.
  • Privacy and Identity Theft web page. Information about how to prevent and recover from identity theft.

Identity Theft Policies and Procedures

Community Health Plan identity theft prevention and breach notification policies and procedures are available for you to read. To get copies of them sent to you, call the Community Health Plan customer service team at 1-800-440-1561, Monday through Friday from 8:00 am to 5:00 pm, or email customercare@chpw.org. If you are hearing or speech impaired, please call TTY Relay: Dial 7-1-1.