The High Price of Medical Identity Theft and Fraud. Ann Patterson Medical Identity Fraud Alliance

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1 The High Price of Medical Identity Theft and Fraud The High Price of Medical Identity Theft and Fraud Ann Patterson Medical Identity Fraud Alliance

2 Medical Identity Theft Primer Includes theft of Protected Health Information (PHI) and/or Personally Identifiable Information (PII) for the purpose of financial gain or to unlawfully obtain medical goods or services Victims include the patient, healthcare providers, insurance companies, taxpayers and consumers who subsequently pay higher prices for their care Contributing factors Pervasiveness of electronic PHI Significant increase in the value of PHI because of its use by hackers and criminal organizations Increasing number of individuals with healthcare benefits Increasing alternative delivery models that include care outside of facilities Lack of coordinated response by public and private sectors to protect the privacy and security of PHI Changing legal and regulatory landscape as law keeps pace with technology, there will be additional regulations and increasing penalties for noncompliance 2

3 Some Facts Fraud adds $80 billion in excess costs to health care annually 1 $41.3 billion per annum estimated economic impact million medical records have been disclosed since in 4 chance of being a victim of identity fraud as a result of data breach 4 The average per record cost of a data breach for U.S. organizations is $188 6 Only 15% of insured adults familiar with medical identity theft 5 Growth in Electronic Health Records (EHR) and the new health insurance exchanges will magnify the problem Stolen, ransomed or misused patient data is at the core of many crimes perpetrated by the gamut of fraudsters, including organized crime National Academy of Sciences Health Care Study Javelin Strategy & Research Identity Fraud Report financial-pain-ensues-when-custodians-of-health- fail-to-be-good-stewards-of-privacy/ Harris Interactive/Nationwide Study: Few Aware of Risk of Medical Identity Theft Ponemon Institute Research Report: 2013 Cost of Data Breach Study Global Analysis 3

4 Survey on Medical Identity Theft The 2013 Survey on Medical Identity Theft, conducted by Ponemon Institute and sponsored by MIFA with support from ID Experts, measures the prevalence of medical identity theft in the United States and its impact on consumers Surveyed 788 adults (aged 18+), who self-reported they or close family members were victims of medical identity theft For purposes of the study, medical identity theft occurs when someone uses an individual s name and personal identity to fraudulently receive medical service, prescription drugs and goods, including attempts to commit fraudulent billing The survey was designed with input from: Federal Trade Commission Department of Justice Federal Bureau of Investigation 4

5 Survey Highlights Medical identity theft is growing base rate of victims has increased from.53% in 2010 to.82% in million estimated adult-aged victims of medical identity theft in ,000 estimated new victims in % increase in medical identity theft from 2012 to 2013 $12 billion out-of-pocket costs for victims Reputational risks for healthcare providers 5

6 Impact on Victims 64% did not incur any out-of-pocket costs 36% paid an average of $18,660 73% suffered other types of financial consequences; e.g., diminished credit score or financial ID theft Resolution of the crime is time-consuming 36% of respondents report it took a year or more to resolve the problems Misdiagnosis, mistreatment or delay in treatment 6

7 Lacking Awareness Individuals lack awareness of the seriousness of the crime 50% do not take any steps to protect themselves from medical identity theft 50% not aware medical identity theft can create inaccuracies in their permanent medical records 7

8 Education Needed 56% do not check their medical records for accuracy 51% don t know how 45% trust their providers to be accurate 38 did not think of it 30% records not easily accessible 21% don t care 54% do not review their EOBs 25% trust accuracy 18% do not understand 11% not important 8

9 Fraud May Be Preventable Sharing of personal identification for medical services is prevalent 58% shared their personal identification or medical credentials with someone they knew 30% knowingly shared 28% family member took identification or medical credentials without consent 9

10 Industry Costs 8200 out of every 1 million Americans will be a victim or, or complicit in, medical identity fraud 58% of cases involved sharing medical ID with an acquaintance (4760 out of 8200) $7,598 estimated average annual per capita cost for health care in the US (Kaiser Family Foundation)* The cost of health care to false identities is approximately $36M (4760 x $7,598) for every 1M insured individuals Medical identity fraud is generally not reported the actual costs may be higher * 10

11 Potential Consequences to Victims Financial ID theft Diminished credit score Lost time and productivity trying to fix inaccuracies in records Legal fees Employment related difficulties Revocation of licenses 11

12 Consequences of Medical ID Theft/Fraud 56% of victims lost trust/confidence in healthcare provider 15% Misdiagnosis 13% Mistreatment 11% Incorrect medication prescribed 14% Delay in receiving care 43% Paid out-of-pocket payments to health plan 39% Loss of health insurance 7% Increase in insurance premiums 12

13 What MIFA is Doing Mobilizing stakeholders patients, healthcare providers, insurers, service providers, regulators, legislators Building industry cooperation, consensus, and information sharing Conducting research Raising awareness and educating everyone in the ecosystem And Empowering individuals to protect their health information 13

14 For More Information Ann Patterson Senior Vice President and Program Director