Healthcare News & Insights

Reduce liability for provider-ID theft

Identity theft can be devastating for physicians and the facilities they work for, consuming significant time and substantial financial resources. 

Years ago, physicians and their facilities didn’t have to worry all that much about identity theft. But nowadays, it happens more than you may think – unscrupulous individuals acquire providers’ identification and use it to commit fraud.

The good news is, there’s a new way to protect providers from the mayhem identify theft can cause.

The Centers for Medicare & Medicaid Services (CMS) created the provider victim validation/remediation initiative. It assists providers whose ID has been stolen and used to defraud federal healthcare programs.

Program integrity contractors assigned to different regions investigate the situation, after being notified by a potential victim. The American Medical Association (AMA) lists contact information for the contractors on its website.

These contractors investigate providers’ complaints, and generate a report to CMS for a final decision on whether to relieve providers of fraud liability based upon the evidence.

Providers who haven’t suffered any financial liability yet, but suspect they have been an identity theft victim, should contact their Medicare Administrative Contractors (MACs) or the Department of Health and Human Services Office of the Inspector General (800-HHS-TIPS).

In the past many physicians haven’t been able to clear their names and struggled to get their reputation and finances back on track, since there wasn’t an entity to help them. And not being able to clear up bad debts from fraudulent billing had devastating effects.

In addition, this kind of illegal access compromises privacy issues and causes HIPAA violations  — something no facility wants to deal with.

Now this new streamlined process gives physicians the help and resources they need when facing a devastating and complicated issue like identity theft.

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