Crime Watch

Crime Watch: Retired fraud investigator weighs in on risks of identity theft, fraud

 

Special to The Miami Herald

Today I am going to share an excellent letter from a reader regarding Medicare’s continued practice of using Social Security numbers to identify patients. As you recall, this poses a risk of identity theft.

Carmen,

I have been reading with great interest your articles about Medicare using Social Security numbers for patient healthcare ID's. I was the manager of the Medical Fraud Unit for Blue Cross Blue Shield of Florida (Now Florida Blue), for over eight years. The mission of our unit was to identify medical fraud on the part of medical providers, facilities, suppliers and patients themselves. During our investigations, we worked closely with local, state and federal law-enforcement agencies to pursue both criminal action and or civil recovery of monies improperly paid to the entities mentioned above.

During my tenure and involvement on a national level with other investigators, it always amazed me that the federal government continued to use the Social Security numbers of patients as their health care ID. It was in fact a federal mandate that required all private carriers to de-link social security numbers from health care ID's. It makes no sense for the Federal Government to make this mandate for the private carriers and yet Medicare, the largest carrier, was not required to follow this mandate. Private carriers when advised that health care ID is being used for submission of potential fraudulent claims can both flag the health care ID number and with minimal inconvenience to the patient issue the a new health care ID. Although Medicare has the potential to flag Social Security numbers, it causes disruptions to additional care sought by the patient and may prevent the patient from receiving needed services. In addition, they can also flag the provider involved. That being said, Medicare is a pay-and-chase agency. Claims are paid quickly, and dollars for fraudulent services have to be chased to attempt recovery of dollars. Usually the money has either left the country and or has been spent so the amount recovered is usually small. Millions and millions of dollars are paid by the federal government to bogus providers for services not rendered.

The Social Security numbers of Medicare patients are marketed between shady businesses and phony medical clinics. There is technically no harm to the patient because a bogus provider won't bill a bogus claim to a patient who never received services. The goal of the bogus clinics is to file as many fraudulent claims as possible, get their checks through a drop box and move on. The never have to see a single patient.

By following their own mandate to the private sector, the federal government could significantly reduce exposure and control and reduce their exposure to fraudulent claims. You can't issue individuals new Social Security numbers because that unique number is a historical financial tracking number used by many federal agencies. Having that number out there for Medicare patients only increases fraudulent activities and also increases potential for very complex identity theft situations.

Your pursuit of this change is commendable and I salute your efforts.

Gary MacDonald

Carmen Caldwell is executive director of Citizens’ Crime Watch of Miami-Dade. Send feedback and news for this column to carmen@citizenscrimewatch.org, or call her at 305-470-1670.

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