Updated on: October 23, 2019

Identity Theft in Long-Term Care

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Original story posted on: October 22, 2019

There are resources available to help prevent wrongdoers from successfully targeting vulnerable patient populations.

A dirty little secret of the long-term care industry is that the problem of identity theft arises more often than is reported. 

In all fraud, there is the fraud triangle. The triangle sides are pressure, opportunity, and rationalization.  

Let’s start with pressure. Minimum wages have not increased since 2009. Most of the nurses and aides working in long-term care are paid minimum wage. Additionally, most long-term care providers offer little in the way of benefits.

The opportunity is huge. You have 100 or more people who usually have stopped filing taxes or checking their credit reports. Caregivers have patients’ names and birthdates, at a minimum, from medical records. Mail and visits from relatives can provide other information like Social Security numbers. 

There is a cottage industry of dishonest tax preparation services that can easily file fraudulent returns and have refunds sent to criminals.

One interesting spin on identity theft is the use of the victim’s insurance benefits. Under this scam, the thief uses the elderly patient’s Medicare card to get medical benefits under the Medicare and Medicaid programs.

The rationalization makes this scarier. The criminals think to themselves that the Internal Revenue Service (IRS) will never make these old people pay back the money from the filing of fraudulent tax returns, and credit card companies will simply write off the balances. If they use the victim’s insurance benefits, they think, Medicare and Medicaid can afford to cover the loss.  

They also may feel that elderly nursing-home patients will never be seriously impacted by low credit scores.

Here is something that shocked me, though. As mentioned, identity theft in long-term care institutions is much more common than is reported. 

What can you do if you have a loved one in a nursing home or other long-term care facility? Review the medical benefit letters of your loved ones. Questionable charges? Contact your healthcare provider first to see if it's a mistake. If your issue is not resolved by your provider, report the questionable charges to 1-800-MEDICARE or contact your local Senior Medicare Patrol for assistance: 1-877-808-2468 or www.SMPResource.org.

Suspect Medicare Fraud? Contact the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) fraud hotline:

Online: oig.hhs.gov/fraud/hotline
Phone: 1-800-447-8477 (1-800-HHS-TIPS)
TTY: 1-800-377-4950 | Fax: 1-800-223-8164

Timothy Powell, CPA CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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