THE RISKS, THE IMPACT AND DEVELOPING SOLUTIONS

Transcription

1 IDENTITY THEFT! THE RISKS, THE IMPACT AND DEVELOPING SOLUTIONS

2 Before We Begin Recording of this Event Your Event Console CPEs Q&A Session Polling Questions Demonstration

3 IDENTITY THEFT! THE RISKS, THE IMPACT AND DEVELOPING SOLUTIONS Linda Vincent, RN. PI. The Identity Advocate

4 Objectives What is Identity Theft What is Medical ID Theft Who is affected How it happens Why you need to know What to do to prevent Identity & Medical ID Theft

5 Identity Theft Act of 1998 Knowingly transfers or uses, without lawful authority, a means of identification of another person with intent to commit or to aid or abet, any unlawful activity that constitutes a violations of Federal law, or that constitutes a felony under any applicable State or local law. act.htm

6 Identity Theft Enhancement Act July 2004 Established a new crime, aggravated identity theft defined use of stolen identity to commit other crimes federal crimes passports, immigration i violations, firearms Carries a mandatory 2 year prison term Now a 5 year term IF connected to terrorism

7 Who Steals Your Information? Relatives/friends Organized crime rings Corrupt healthcare e workers Mail thieves

8 What Criminals i Steal Names Addresses Dates of birth Employment information Healthcare information

9 What Else Criminals i Steal Social Security numbers Driver s license numbers Utility and other household bills Credit card numbers

10 How Information is Stolen Dumpster diving Mail theft Check washing Stolen wallets Telephone and Scams Obtaining dead people s information

11 The Price of Identity Social Security Number Street value - $1.00 Medical Identity Information Street value - $50.00

12 Identity Theft Scams Credit card skimming Electronic Pick Pocket Devices Inmate Federal Prison ID Theft Ring Armenian gangs and 99 cent Stores

13 What Is Medical Identity Theft? Loss of individual health care information Loss of provider information Loss of hospital data information Loss of healthcare provider information

14 Medical Identity Theft Statistics ti ti About 3% of ID theft crimes 250,000 cases Currently 83% of providers have data breaches/yr Now 41% of Hosp have more than 10 breaches/yr VA lost 26 million files 50 million Americans affected Only 1 in 700 identity thieves are arrested

15 Types of Medical Identity Theft Physicians Patients Health Care Card Information

16 Medicare Identity Theft Statistics ti ti Compromised IDs Medicare Program More than 200,000 Member IDs have been compromised More than 4,900 False Front Providers identified Source: CMS PSC, Western Integrity Center, May 2010

17 Medicare Physician i Scam Dead Doctors Used to Scam Government Money t / / /OPENINGSTMTC ll i 908.pdf Senate Hearing Viewable at: senate gov/public/index cfm?fuseaction=hearings Hearing&Hearing_id=eb f1-4b55-826e-a9bf c Fraudulent providers submitted claims based on orders from some doctors who were dead for 10 years or more From 2000 to 2007, Medicare paid between $60M & $93M for claims where the ordering or prescribing doctor had been dead for at least 12 months

18 The Other Thieves in Medical Identity Theft Dishonest patients Dishonest providers (individuals or institutions) Professional criminals/bogus providers Other parties to the system Dishonest billing services Dishonest payer employees Non-practitioner ring participants Attorneys Recruiters/ cappers

19 The Impact of Medical Identity Theft Death Medical records in shambles Lifetime maximum exceeded Physical harm Credit issues Employment issues

20 Further Challenges Pre-certification of treatment Cost of treatment Unable to obtain other coverage Denial of services Employment issues

21 Other Contributing ti Factors Cuts in employer-funded health care coverage Numbers of active workers vs number of retirees Higher premium share, deductibles, treatment co-pays High unemployment Growing uninsured population Confusion/controversy over health care reform

22 Medical Identity Theft Scams Orange County Plastic Surgery Case -- Implants Seattle Cancer Care HIPAA Health Care Provider Tax Cases in LA County Glendale/Medicare Organized crime ring

23 Deceased but not Dead and Gone Deceased Members Deceased Performing Providers Deceased Ordering Providers

24 Corporate Identity Theft Knowledge of the red flags of fraud What it means to the company Liability issues IT departments security data security

25 Corporate Prevention Strategies t Authorized persons for sensitive data Enforce Identity Theft policy & procedure Monitor Company Credit Reports Perform background checks on all employees

26 Identity Theft Prevention SHRED EVERYTHING! Review credit reports 1x/yr - each agency Place a fraud alert every 90 days Place a credit freeze with each credit bureau Use gel pens

27 Seven Ways to Avoid Medical Identity Theft 1. Always check EOBs (explanation of benefits) 2. Eliminate your SSN from records 3. Have your own copy of your health record 4. Review and dispute claims that aren t yours 5. Check credit reports 6. Shred everything 7. Never partake of free medical care

28 Seven Ways to Prevent Identity Theft 1. Check credit history 2. Use only your initials on your checks 3. Use gel pens 4. Never put entire account numbers on checks 5. Sign back of CC with Photo ID required 6. NEVER put SSN on checks 7. Make a copy of all contents in your wallet

29 Seven Things to do if it Happens to You 1. Call 877-ID-Theft ( ) - FTC 2. Call Police-file a police report 3. Put a fraud alert on your credit report Renew it every 90 days 4. Get a copy of your credit reports 5. Freeze your credit 6. Call your bank 7. Cancel credit cards

30 Obtaining i Credit Information Online: www annualcreditreport com Online: Call: Visit: blogs at

31 Individual id Credit ditagencies Equifax Ordering single credit report Experian Also Transunion Also fraud alerts Social Security Administration Federal Trade Commission IRS Theft Hotline at

32 Freezing Your Credit Equifax, Transunion or Experian Send certified letter with full name, SSN State wish to place a SECURITY FREEZE Enclose copy of some government issued ID See complete details at

33 Opt Out of Pre-Approved Credit Cards or Junk Mail Call Visit Mail Preference Service Direct Marketing Association P.O. Box 643, Carmel, NY 10512

34 Handy Web Sites t

35 Action Items Build Awareness & Educate, Educate, Educate Staff, Supervisors & Friends, too Join Newsgroups, Blogs, Social Media (Facebook, Twitter), Identity Theft and Fraud is Discussed Join Anti-Fraud Organizations (Local & National) Dedicate Resources to Fraud Identification & Prevention Encourage Staff to Review Suspicious Claims Perform Annual Member & Beneficiary Audits Conduct Special Audits as the Claims Environment or Benefit Environment Changes (i.e., new benefits instituted, new claims systems implemented, etc.)

36 Questions Thank you for your participationp Linda Vincent, RN. PI. com

37 In addition to the complimentary monthly Members-Only Webinar Series, you can expect the following added benefits in 2011: Members-only access to Internal Auditor magazine quizzes to earn CPEs Complimentary access to the members-only webinar archive Expansion of the Audit Executive Center Enhanced member affinity program

38 THANK YOU TO OUR SPONSOR