tci Medicare Compliance & Reimbursement - 2024 Issue Q2

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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