When you receive your explanation of benefits in the mail after paying a visit to the doctor, you may feel like you are being robbed due to the high charges. However, if you are Anne Peters, MD, the financial crimes committed against you are the real thing. Dr. Peters was the victim of a fairly common but rarely talked about form of fraud: physician identity theft.
Peters first learned about this crime approximately six years ago when doctors in her home state of California started phoning her. The other doctors’ patients were telling them that Peters was billing for procedures she hadn’t performed. This was the first she had heard of it. Medicare was paying out these claims, but the money was not going to Peters.
Peters reported the crimes to the Centers for Medicare and Medicaid Services, which did not serve her well at first. She was prosecuted for grand theft, to the tune of over $650,000, and she was asked to pay back taxes on the Medicare payments…. so much for being an honest whistle blower.
It’s likely that the thief was able to use Peters’ information to perpetrate this scam because he got a hold of her physician credentialing numbers. That’s pretty much all you need to impersonate and doctor on paper, and security is rather lax. According to Pam Dixon of the World Privacy Forum, “This information is far too publicly available … It’s really out there.”
The government has taken some steps recently to make it easier for victimized physicians to clear their names. For example, the Center for Program Integrity now offers a remediation initiative. This is not enough, though, and one of the problems is politics. While some say greater protection is needed for doctors, other attest that it would be too cumbersome to put in additional safeguards when so many organizations in the medical field need access to physician credentials.
One of the biggest helps right now is moving the issue into the public eye. Peters complains that there was no one she could speak with regarding the identity theft that happened to her. “I couldn’t get anyone to believe I was innocent.”