Hello again, I'm Clayton Vandiver, your light
keeper on the Light Keepers podcast. Out in the
middle of the Pacific Ocean once again, because
even though we're a thousand miles from shore,
we wanted to make sure we continue to bring you
important information that helps you live a better
life, because that's what this show is all about.
And with me, of course, today, Charlene Vanver,
our licensed clinical social worker that's windblown.
And we're on the cruise ship. It's very active.
You'll hear a lot of background, you know, sounds
going on. But we wanted to make sure we brought
you another episode of important information.
Today, continuing, it's not really a part four
on HIPAA, but it is on health. Medical identity
theft. Medical identity. theft which is what
happens when a hipaa violation has occurred well
that was really how i followed up our last episode
was well what happens well we'll get into that
in the next episode what are the potential problems
that medical identity theft can cause an individual
so for starters medical identity theft happens
when someone has your insurance information and
your name basically your protected health information
phi which we talked about previously and they
use it to get medical treatment medications um
basically they get all of that in your name and
you get the bill for it and they get the benefit
you get the bill and the consequences can be
staggering first of all it can prevent you from
getting treatment it can prevent you from being
able to get your medications. If your medications
have already been delivered to someone else,
they won't deliver them to you. Correct. But
it can also result in you getting a bill, a fairly
large bill. According to the statistics which
I have here and I'm keeping under the table,
so if you see me looking down, I apologize, but
I don't want my notes to blow away. The wind
is brisk and the ocean is deep. Yeah, I don't
want to go swimming for these. The average cost
of medical identity theft is $22 ,000. Good heavens.
$22 ,000. And a lot of times people don't even
realize that they've been hit with that until
they get a bill in the mail or until they get
a ding on their credit report from a bill that's
gone to collections. And it can take time to
resolve. And while it's being resolved, you're
still financially on the hook. As with any identity
theft. Exactly. Only this can be life -threatening.
And see, and the thing is, and this is something
that I don't know that would be good for us to
reach out to someone and ask, is there are a
ton of agencies out there that protect you against
identity theft financially. Do they cover you
medically? Very important question. I just thought
about that. Oh, wow. Otherwise, we would have
the answer. We would have some research done
on that. We'll get back to you on a later episode
about that. But the thing is, that is a risk.
Now, the most common culprits of medical identity
theft, sadly, is a family member. And sometimes...
Unintentional most of the time, I would assume.
Well, sometimes yes, sometimes no. If you have
a family member who maybe doesn't have insurance
and they can't afford that copay, they may borrow
yours. And by the way, if you are aware of it,
that still doesn't make it okay. It just makes
you equally culpable if something legal does
go down. So helping them in the task. It doesn't
absolve you from the risk. Exactly, because the
other culprit to that is fraudulent billing,
and that's what's happening. If someone is receiving
medical care under your name and it's not you,
that is fraud. Now, an interesting case. I was
at a seminar, and I talked about this a couple
of episodes ago that I would mention in a future
episode. Here we are. I was in a Department of
Elder Affairs for the state of Florida Medicare
seminar. And an investigator who investigates
Medicare fraud was telling us about a group that
they had just finally caught up with and broken
and put in jail. A large group of individuals
who had received compromised medical information,
basically HIPAA violations, medical information
on, what is that called again? Information. The
health insurance portability, not HIPAA. Not
HIPAA. The medical information. The protected
health information, PHI. Protected health information.
The protected, the PHI. Protected health information
of individuals. They had massive databases that
had been compromised of names and birth dates
and individuals. Enough so. that they could file
fraudulent Medicare claims in the state of Florida,
in South Florida, which is a huge concentration
of retirees, which is why it's so easy to hide
and cover. So they do business in South Florida
where it's easy to blend in and do their illegal
activities. They have massive databases of people
who live there, and they use that then to file
Medicare claims. Things that are recurrent, like
dialysis, that someone would be going to on a
very regular basis. And those billings can be
very substantial. And they begin billing for
these things, and sometimes these people are
not even on dialysis. But it's reasonable and
plausible that they might be, and the billing
is coming from what appears to be a medical firm
that is... allowed to bill for Medicare, so they
do, for years, to the tune of many, many millions
of, hundreds of millions of dollars. And they
were, and then they pack up and they move, change
the name of their company, and do it all over
again just before they're taught. And they led
investigators for a very long time on a series
of little, you know, little fox hunts, little
chases, and they finally got caught. They got
put in prison. And the medical investigators
out of Medicare were so pleased that they had
finally put that one to bed and protected the
rights of so many people. But that's an example
of what can happen. It is absolutely critical
that people check their bills. And I know hospitals
and doctor's offices, they don't always bill
transparently. It's not always easy to read.
But I'll give you a great example. When I had
kids, I had my first child, I had all three of
my children without an epidural, without anesthesia.
Which most women might have. Which most women
would have received. When I got the hospital
bill post -delivery. There was a bill on there
for the epidural that I never got. Because it
was such a common procedure. They just went ahead
and tacked it right on. They tack it right on,
and insurance companies don't question it, so
it gets put through. And that's an example of
really what I was just explaining. Fraudulent
billing. A Medicare fraud criminal operation
was doing to Medicare. But this is an example
of what just a normal, everyday hospital is doing.
Accidental billing. accidentally yeah not intending
to but it's just so commonplace they put it through
they also with our um second child no wouldn't
go there another procedure that's common for
many children and it's so commonplace we we elected
not to do that We got billed for it anyway. And
it was on the bill, and I noticed it stood out,
and I contacted the insurance company. I said,
you know, you may not want to pay for this because
we did not receive that service. And the thing
is, if that was somebody who didn't have insurance.
Yes. They would have paid that out of pocket.
And that's a good example. That would have been
an out -of -pocket expense. That would have been
an out -of -pocket. And if they had not gone
through the itemized bill, they would never have
known that they paid a few extra thousand dollars
they didn't need to. That's why it's always so
important to go over those bills. And if you
get an expense, an out -of -pocket expense that
you weren't expecting. Question it. Absolutely.
Question it. My grandmother, whom you were able
to help, fortunately, was billed multiple thousands
of dollars that would have bankrupted her. And
she was panicked over it. And come to find out,
it was an error in billing. One code off. And
one sheet on a Medicaid form. One sheet hadn't
been signed. All the other forms had been. One
sheet had not been signed. And for that, Medicaid
kept kicking it back. And she didn't know why.
Nobody knew why. We found someone at an area
agency on aging that identified that problem.
Said, all we need to do is sign this one sheet
and this will go through. It'll fly right through.
And it did. And she was, it lifted such a weight
off of her shoulders. That was, that was, you
know. Truly life -changing for her because she
was so stressed over that. It's all in the details.
It's all in the details, and that's why it is
absolutely so critical. I cannot stress it enough.
Look over the bills, and if there is anything
on there that you don't understand or if it's
not the amount you were expecting, question it.
Yes. Question it. And one of the details that
we have to fulfill now is we've run out of time.
Again. All of these conversations that we have
are to put the ideas in your mind of questions
that you might want to ask, thoughts that you
might want to research. Definitely do not take
any information from the Light Keepers podcast
and apply it directly to your unique individual
life. Take these thoughts and ideas to your medical
professionals or other professionals in their
fields. and let them apply these thoughts to
your unique needs in your particular situation
provide the specific guidance that you need right
absolutely so once again we appreciate you being
with us today on the light keepers podcast click
that like and subscribe and that little bell
that uh that reminds you when we put up another
episode and we'll be back again with more information
about the times that HIPAA fails and what can
happen in your life that we don't want to have
happen because this show is all about living
the very best life possible with the best information
we can possibly get to you. From the middle of
the Pacific Ocean, I'm Clayton Vandiver, your
light keeper. We'll see you next time.