WEBVTT 00:00:00.000 --> 00:00:02.200 Hello again, I'm Clayton Vandiver, your light 00:00:02.200 --> 00:00:05.440 keeper on the Light Keepers podcast. Out in the 00:00:05.440 --> 00:00:08.480 middle of the Pacific Ocean once again, because 00:00:08.480 --> 00:00:10.859 even though we're a thousand miles from shore, 00:00:10.960 --> 00:00:12.720 we wanted to make sure we continue to bring you 00:00:12.720 --> 00:00:17.359 important information that helps you live a better 00:00:17.359 --> 00:00:20.000 life, because that's what this show is all about. 00:00:44.170 --> 00:00:46.450 And with me, of course, today, Charlene Vanver, 00:00:46.549 --> 00:00:50.890 our licensed clinical social worker that's windblown. 00:00:51.130 --> 00:00:54.270 And we're on the cruise ship. It's very active. 00:00:54.329 --> 00:00:56.770 You'll hear a lot of background, you know, sounds 00:00:56.770 --> 00:00:59.409 going on. But we wanted to make sure we brought 00:00:59.409 --> 00:01:01.549 you another episode of important information. 00:01:02.329 --> 00:01:05.569 Today, continuing, it's not really a part four 00:01:05.569 --> 00:01:10.310 on HIPAA, but it is on health. Medical identity 00:01:10.310 --> 00:01:13.030 theft. Medical identity. theft which is what 00:01:13.030 --> 00:01:16.250 happens when a hipaa violation has occurred well 00:01:16.250 --> 00:01:18.569 that was really how i followed up our last episode 00:01:18.569 --> 00:01:21.349 was well what happens well we'll get into that 00:01:21.349 --> 00:01:24.870 in the next episode what are the potential problems 00:01:24.870 --> 00:01:28.530 that medical identity theft can cause an individual 00:01:28.530 --> 00:01:32.469 so for starters medical identity theft happens 00:01:32.469 --> 00:01:37.500 when someone has your insurance information and 00:01:37.500 --> 00:01:40.140 your name basically your protected health information 00:01:40.140 --> 00:01:43.620 phi which we talked about previously and they 00:01:43.620 --> 00:01:47.879 use it to get medical treatment medications um 00:01:47.879 --> 00:01:53.260 basically they get all of that in your name and 00:01:53.260 --> 00:01:57.299 you get the bill for it and they get the benefit 00:01:57.299 --> 00:02:00.780 you get the bill and the consequences can be 00:02:00.780 --> 00:02:05.200 staggering first of all it can prevent you from 00:02:05.200 --> 00:02:08.460 getting treatment it can prevent you from being 00:02:08.460 --> 00:02:10.939 able to get your medications. If your medications 00:02:10.939 --> 00:02:13.460 have already been delivered to someone else, 00:02:13.639 --> 00:02:16.860 they won't deliver them to you. Correct. But 00:02:16.860 --> 00:02:20.340 it can also result in you getting a bill, a fairly 00:02:20.340 --> 00:02:23.840 large bill. According to the statistics which 00:02:23.840 --> 00:02:25.800 I have here and I'm keeping under the table, 00:02:25.879 --> 00:02:28.240 so if you see me looking down, I apologize, but 00:02:28.240 --> 00:02:30.080 I don't want my notes to blow away. The wind 00:02:30.080 --> 00:02:32.599 is brisk and the ocean is deep. Yeah, I don't 00:02:32.599 --> 00:02:35.919 want to go swimming for these. The average cost 00:02:35.919 --> 00:02:40.479 of medical identity theft is $22 ,000. Good heavens. 00:02:40.659 --> 00:02:44.219 $22 ,000. And a lot of times people don't even 00:02:44.219 --> 00:02:47.460 realize that they've been hit with that until 00:02:47.460 --> 00:02:49.879 they get a bill in the mail or until they get 00:02:49.879 --> 00:02:52.500 a ding on their credit report from a bill that's 00:02:52.500 --> 00:02:56.659 gone to collections. And it can take time to 00:02:56.659 --> 00:02:59.719 resolve. And while it's being resolved, you're 00:02:59.719 --> 00:03:02.520 still financially on the hook. As with any identity 00:03:02.520 --> 00:03:05.819 theft. Exactly. Only this can be life -threatening. 00:03:06.000 --> 00:03:08.060 And see, and the thing is, and this is something 00:03:08.060 --> 00:03:10.840 that I don't know that would be good for us to 00:03:10.840 --> 00:03:14.259 reach out to someone and ask, is there are a 00:03:14.259 --> 00:03:17.759 ton of agencies out there that protect you against 00:03:17.759 --> 00:03:21.860 identity theft financially. Do they cover you 00:03:21.860 --> 00:03:28.800 medically? Very important question. I just thought 00:03:28.800 --> 00:03:32.479 about that. Oh, wow. Otherwise, we would have 00:03:32.479 --> 00:03:34.800 the answer. We would have some research done 00:03:34.800 --> 00:03:36.960 on that. We'll get back to you on a later episode 00:03:36.960 --> 00:03:39.340 about that. But the thing is, that is a risk. 00:03:39.479 --> 00:03:42.939 Now, the most common culprits of medical identity 00:03:42.939 --> 00:03:47.699 theft, sadly, is a family member. And sometimes... 00:03:47.699 --> 00:03:49.680 Unintentional most of the time, I would assume. 00:03:49.960 --> 00:03:54.280 Well, sometimes yes, sometimes no. If you have 00:03:54.280 --> 00:03:56.379 a family member who maybe doesn't have insurance 00:03:56.379 --> 00:04:00.500 and they can't afford that copay, they may borrow 00:04:00.500 --> 00:04:06.539 yours. And by the way, if you are aware of it, 00:04:06.599 --> 00:04:09.000 that still doesn't make it okay. It just makes 00:04:09.000 --> 00:04:12.780 you equally culpable if something legal does 00:04:12.780 --> 00:04:18.540 go down. So helping them in the task. It doesn't 00:04:18.540 --> 00:04:22.439 absolve you from the risk. Exactly, because the 00:04:22.439 --> 00:04:24.560 other culprit to that is fraudulent billing, 00:04:24.660 --> 00:04:27.279 and that's what's happening. If someone is receiving 00:04:27.279 --> 00:04:29.540 medical care under your name and it's not you, 00:04:29.759 --> 00:04:33.579 that is fraud. Now, an interesting case. I was 00:04:33.579 --> 00:04:35.980 at a seminar, and I talked about this a couple 00:04:35.980 --> 00:04:37.899 of episodes ago that I would mention in a future 00:04:37.899 --> 00:04:42.160 episode. Here we are. I was in a Department of 00:04:42.160 --> 00:04:44.899 Elder Affairs for the state of Florida Medicare 00:04:44.899 --> 00:04:49.910 seminar. And an investigator who investigates 00:04:49.910 --> 00:04:54.029 Medicare fraud was telling us about a group that 00:04:54.029 --> 00:04:57.910 they had just finally caught up with and broken 00:04:57.910 --> 00:05:01.790 and put in jail. A large group of individuals 00:05:01.790 --> 00:05:06.769 who had received compromised medical information, 00:05:06.790 --> 00:05:12.470 basically HIPAA violations, medical information 00:05:12.470 --> 00:05:17.170 on, what is that called again? Information. The 00:05:17.170 --> 00:05:20.529 health insurance portability, not HIPAA. Not 00:05:20.529 --> 00:05:22.550 HIPAA. The medical information. The protected 00:05:22.550 --> 00:05:24.990 health information, PHI. Protected health information. 00:05:25.069 --> 00:05:27.970 The protected, the PHI. Protected health information 00:05:27.970 --> 00:05:31.990 of individuals. They had massive databases that 00:05:31.990 --> 00:05:36.009 had been compromised of names and birth dates 00:05:36.009 --> 00:05:39.579 and individuals. Enough so. that they could file 00:05:39.579 --> 00:05:43.160 fraudulent Medicare claims in the state of Florida, 00:05:43.240 --> 00:05:45.620 in South Florida, which is a huge concentration 00:05:45.620 --> 00:05:50.300 of retirees, which is why it's so easy to hide 00:05:50.300 --> 00:05:53.759 and cover. So they do business in South Florida 00:05:53.759 --> 00:05:59.040 where it's easy to blend in and do their illegal 00:05:59.040 --> 00:06:02.060 activities. They have massive databases of people 00:06:02.060 --> 00:06:06.360 who live there, and they use that then to file 00:06:06.360 --> 00:06:10.360 Medicare claims. Things that are recurrent, like 00:06:10.360 --> 00:06:13.300 dialysis, that someone would be going to on a 00:06:13.300 --> 00:06:17.180 very regular basis. And those billings can be 00:06:17.180 --> 00:06:21.519 very substantial. And they begin billing for 00:06:21.519 --> 00:06:26.279 these things, and sometimes these people are 00:06:26.279 --> 00:06:29.620 not even on dialysis. But it's reasonable and 00:06:29.620 --> 00:06:32.819 plausible that they might be, and the billing 00:06:32.819 --> 00:06:36.100 is coming from what appears to be a medical firm 00:06:36.100 --> 00:06:40.759 that is... allowed to bill for Medicare, so they 00:06:40.759 --> 00:06:45.879 do, for years, to the tune of many, many millions 00:06:45.879 --> 00:06:50.259 of, hundreds of millions of dollars. And they 00:06:50.259 --> 00:06:52.980 were, and then they pack up and they move, change 00:06:52.980 --> 00:06:55.019 the name of their company, and do it all over 00:06:55.019 --> 00:06:57.819 again just before they're taught. And they led 00:06:57.819 --> 00:07:01.660 investigators for a very long time on a series 00:07:01.660 --> 00:07:04.519 of little, you know, little fox hunts, little 00:07:04.519 --> 00:07:08.779 chases, and they finally got caught. They got 00:07:08.779 --> 00:07:11.759 put in prison. And the medical investigators 00:07:11.759 --> 00:07:14.879 out of Medicare were so pleased that they had 00:07:14.879 --> 00:07:16.819 finally put that one to bed and protected the 00:07:16.819 --> 00:07:19.740 rights of so many people. But that's an example 00:07:19.740 --> 00:07:23.439 of what can happen. It is absolutely critical 00:07:23.439 --> 00:07:27.879 that people check their bills. And I know hospitals 00:07:27.879 --> 00:07:30.899 and doctor's offices, they don't always bill 00:07:30.899 --> 00:07:33.480 transparently. It's not always easy to read. 00:07:33.579 --> 00:07:37.839 But I'll give you a great example. When I had 00:07:37.839 --> 00:07:43.079 kids, I had my first child, I had all three of 00:07:43.079 --> 00:07:47.720 my children without an epidural, without anesthesia. 00:07:47.860 --> 00:07:50.779 Which most women might have. Which most women 00:07:50.779 --> 00:07:54.959 would have received. When I got the hospital 00:07:54.959 --> 00:07:59.100 bill post -delivery. There was a bill on there 00:07:59.100 --> 00:08:01.519 for the epidural that I never got. Because it 00:08:01.519 --> 00:08:03.800 was such a common procedure. They just went ahead 00:08:03.800 --> 00:08:05.800 and tacked it right on. They tack it right on, 00:08:05.800 --> 00:08:08.060 and insurance companies don't question it, so 00:08:08.060 --> 00:08:10.680 it gets put through. And that's an example of 00:08:10.680 --> 00:08:13.579 really what I was just explaining. Fraudulent 00:08:13.579 --> 00:08:17.420 billing. A Medicare fraud criminal operation 00:08:17.420 --> 00:08:20.199 was doing to Medicare. But this is an example 00:08:20.199 --> 00:08:24.279 of what just a normal, everyday hospital is doing. 00:08:24.300 --> 00:08:26.980 Accidental billing. accidentally yeah not intending 00:08:26.980 --> 00:08:29.540 to but it's just so commonplace they put it through 00:08:29.540 --> 00:08:36.039 they also with our um second child no wouldn't 00:08:36.039 --> 00:08:40.620 go there another procedure that's common for 00:08:40.620 --> 00:08:47.000 many children and it's so commonplace we we elected 00:08:47.000 --> 00:08:50.100 not to do that We got billed for it anyway. And 00:08:50.100 --> 00:08:52.639 it was on the bill, and I noticed it stood out, 00:08:52.720 --> 00:08:54.960 and I contacted the insurance company. I said, 00:08:55.000 --> 00:08:58.620 you know, you may not want to pay for this because 00:08:58.620 --> 00:09:00.500 we did not receive that service. And the thing 00:09:00.500 --> 00:09:04.320 is, if that was somebody who didn't have insurance. 00:09:05.149 --> 00:09:07.830 Yes. They would have paid that out of pocket. 00:09:07.830 --> 00:09:08.909 And that's a good example. That would have been 00:09:08.909 --> 00:09:10.470 an out -of -pocket expense. That would have been 00:09:10.470 --> 00:09:12.309 an out -of -pocket. And if they had not gone 00:09:12.309 --> 00:09:15.049 through the itemized bill, they would never have 00:09:15.049 --> 00:09:17.149 known that they paid a few extra thousand dollars 00:09:17.149 --> 00:09:19.549 they didn't need to. That's why it's always so 00:09:19.549 --> 00:09:22.629 important to go over those bills. And if you 00:09:22.629 --> 00:09:27.289 get an expense, an out -of -pocket expense that 00:09:27.289 --> 00:09:30.190 you weren't expecting. Question it. Absolutely. 00:09:30.210 --> 00:09:33.190 Question it. My grandmother, whom you were able 00:09:33.190 --> 00:09:38.129 to help, fortunately, was billed multiple thousands 00:09:38.129 --> 00:09:41.149 of dollars that would have bankrupted her. And 00:09:41.149 --> 00:09:43.350 she was panicked over it. And come to find out, 00:09:43.370 --> 00:09:47.850 it was an error in billing. One code off. And 00:09:47.850 --> 00:09:54.669 one sheet on a Medicaid form. One sheet hadn't 00:09:54.669 --> 00:09:57.460 been signed. All the other forms had been. One 00:09:57.460 --> 00:09:59.419 sheet had not been signed. And for that, Medicaid 00:09:59.419 --> 00:10:01.259 kept kicking it back. And she didn't know why. 00:10:01.340 --> 00:10:04.759 Nobody knew why. We found someone at an area 00:10:04.759 --> 00:10:07.799 agency on aging that identified that problem. 00:10:08.100 --> 00:10:10.519 Said, all we need to do is sign this one sheet 00:10:10.519 --> 00:10:12.659 and this will go through. It'll fly right through. 00:10:12.840 --> 00:10:16.960 And it did. And she was, it lifted such a weight 00:10:16.960 --> 00:10:20.080 off of her shoulders. That was, that was, you 00:10:20.080 --> 00:10:24.019 know. Truly life -changing for her because she 00:10:24.019 --> 00:10:26.340 was so stressed over that. It's all in the details. 00:10:26.559 --> 00:10:28.620 It's all in the details, and that's why it is 00:10:28.620 --> 00:10:32.759 absolutely so critical. I cannot stress it enough. 00:10:33.100 --> 00:10:35.759 Look over the bills, and if there is anything 00:10:35.759 --> 00:10:38.659 on there that you don't understand or if it's 00:10:38.659 --> 00:10:41.419 not the amount you were expecting, question it. 00:10:41.440 --> 00:10:43.820 Yes. Question it. And one of the details that 00:10:43.820 --> 00:10:46.120 we have to fulfill now is we've run out of time. 00:10:47.120 --> 00:10:51.259 Again. All of these conversations that we have 00:10:51.259 --> 00:10:54.860 are to put the ideas in your mind of questions 00:10:54.860 --> 00:10:57.419 that you might want to ask, thoughts that you 00:10:57.419 --> 00:11:00.799 might want to research. Definitely do not take 00:11:00.799 --> 00:11:03.440 any information from the Light Keepers podcast 00:11:03.440 --> 00:11:07.519 and apply it directly to your unique individual 00:11:07.519 --> 00:11:11.519 life. Take these thoughts and ideas to your medical 00:11:11.519 --> 00:11:13.639 professionals or other professionals in their 00:11:13.639 --> 00:11:17.639 fields. and let them apply these thoughts to 00:11:17.639 --> 00:11:20.620 your unique needs in your particular situation 00:11:20.620 --> 00:11:24.100 provide the specific guidance that you need right 00:11:24.100 --> 00:11:28.360 absolutely so once again we appreciate you being 00:11:28.360 --> 00:11:32.159 with us today on the light keepers podcast click 00:11:32.159 --> 00:11:34.639 that like and subscribe and that little bell 00:11:34.639 --> 00:11:37.940 that uh that reminds you when we put up another 00:11:37.940 --> 00:11:41.559 episode and we'll be back again with more information 00:11:41.559 --> 00:11:45.799 about the times that HIPAA fails and what can 00:11:45.799 --> 00:11:49.500 happen in your life that we don't want to have 00:11:49.500 --> 00:11:51.419 happen because this show is all about living 00:11:51.419 --> 00:11:54.220 the very best life possible with the best information 00:11:54.220 --> 00:11:57.480 we can possibly get to you. From the middle of 00:11:57.480 --> 00:12:00.039 the Pacific Ocean, I'm Clayton Vandiver, your 00:12:00.039 --> 00:12:02.059 light keeper. We'll see you next time.