tci ED Coding & Reimbursement Alert - 2024 Issue Q3

Reader Questions: Distinguish Medical Identity Theft From Other Types of Fraud

Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber Answer: Identity theft is the theft of personal, private, financial information for some type of individual gain, says Kelly A Shew, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, CEMC. Medical identity theft is when a person uses someone else’s information, including their insurance policy, to get services for themselves. Fraudulent claims are for services that were not actually rendered or weren’t medically necessary — it’s either billing services to patients who don’t need them or billing for services that weren’t provided, Shaw...

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