Physicians being targeted in identity theft scheme

The OIG says scammers are getting the information so they can file false claims with Medicare.

By Katherine Vogt — Posted Jan. 31, 2005

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Scam artists posing as Medicare and insurance officials have been targeting minority and immigrant physicians and demanding sensitive identity information, federal authorities have warned.

The Office of the Inspector General for the Dept. of Health and Human Services is investigating the scam and has issued a nationwide advisory about it to Centers for Medicare & Medicaid Services carriers, said OIG spokeswoman Judy Holtz.

Citing the ongoing investigation, Holtz declined to say where the scam had been carried out or how many physicians had been targeted. But she said the scammed doctors numbered "more than a handful," and she cautioned that the scheme could become more widespread.

Holtz said people had been telephoning physicians and representing themselves as either a Medicare fraud investigator, an employee of a major insurance company, or a Medicare audit or claims employee. Then the callers tell the physician or office staffer that the Medicare computer system has had a malfunction and they need to update lost information.

The callers seek several pieces of information, including the physician's driver's license number, Social Security number, universal professional identification number, educational background and date of birth. They also might ask for a copy of the physician's medical license and patient charts.

"If the physician refuses to provide the requested information, they are threatened with either shutting down their practice or coming to their office and conducting an audit," Holtz said.

Based on the information that the callers can glean, they may set up a false provider number, create a fake practice and then falsely bill Medicare. Holtz said it was too early in the investigation to say whether the physicians' identities were being used in any other fraudulent ways.

In January, the Rhode Island Medical Society passed the alert on to its members, though it was unclear whether physicians in that state were among those who had been targeted.

"I thought there was no harm in putting this out there, because I figure it's a good caveat," said Newell E. Warde, PhD, RIMS executive director. "It doesn't hurt to remind people that you want to be very careful with this information, and maybe you want to remind your office managers to be careful, too."

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