Steps to Take If Your Physician Identity is Stolen

A patient calls because he thinks an explanation of benefits he received from a payer doesn’t make sense; you view your Medicare enrollment record and it doesn’t jive with your information; you receive a remittance notice and something just doesn’t look right.

Any of these scenarios could indicate that a fraudster has stolen your unique medical identifier information - such as your NPI, TIN, or medical licensure information - and he may be using it to fraudulently bill payers for medical goods or services you never rendered.

“Identity theft is huge, as we all know statistically … physicians need to protect their own identity just like other individuals do,” nurse and private investigator Linda Vincent, an identity theft prevention expert, told Physicians Practice.

Damages as a result of identity theft could include financial loss due to accumulated taxes on earnings you never received, and obligations to return overpayments to payers for items or services you never rendered.

As soon as you determine your identity has been stolen, take action. The longer you fail to act, the longer the fraudster will be able to manipulate your physician identity and the more damages you will accumulate as a result.

Follow this three-step process:

1. Compile

The first thing to do is collect and assemble all of the information you have that reflects a possible identity theft, Shantanu Agrawal, medical director at CMS’ Center for Program Integrity, which focuses on fraud and abuse issues, told Physicians Practice.

2. Report

Next, tell the relevant agencies that you believe your identity has been stolen. That includes filing a police report with local law enforcement and reporting your concerns to the Federal Trade Commission (FTC) and HHS.

Also, consider placing a fraud alert on credit reports, said Agrawal, who is also an emergency physician. “Raise the flag and say, ‘I think I’ve been a victim of identity theft.’”

Then, tell all payers that you think you may be a victim of identity theft, he said. For instance, just because you learned from a Medicare summary notice that are a victim doesn’t necessarily mean that only your Medicare identity has been implicated.

It’s also important to put a credit freeze on both your business and personal accounts, said Vincent, who is also founder of The Identity Advocate, which provides education, consulting, and resources to help prevent identity theft. Also, cancel all of your credit cards and ask for new card numbers, she said. That’s because if your physician identity is stolen, there might also be a connection to your personal identity, said Vincent.

3. Seek Help

The Center for Program Integrity recently implemented a remediation process to help physicians regain control of their identities and relieve them of related financial harm.
Victimized physicians suffering from financial damages should “absolutely enter into this process,” said Agrawal.

Also, if your identity is stolen and you do not have an identity and recovery service (which often offer an attorney’s services for free), consider seeking legal counsel, said Vincent. "You can always use the help of someone on your side to repair/restore your identity,” she said, noting that it can take years to restore and repair a stolen identity.

Have you been a victim of physician identity theft? What advice would you share with your fellow physicians?