New CMS program to assist physician ID theft victims

The remediation initiative will offer a doctor relief if personal and professional information are used to defraud Medicare or Medicaid.

By Charles Fiegl — Posted Dec. 5, 2011

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A physician who has been victimized by an identity thief now has a new federal option to restore his or her financial integrity and clear bad debts.

The Centers for Medicare & Medicaid Services has created the provider victim validation/remediation initiative for physicians whose identification has been stolen and used to defraud federal health programs.

Physicians can seek resolution from Medicare program safeguard and zone program integrity contractors through the new initiative. These contractors, which operate according to region and state, can investigate instances of identity theft after being notified by a potential victim. The American Medical Association lists contact information for the contractors on its website (link).

These contractors would investigate a physician's complaint and generate a report to CMS for "a final decision whether to relieve providers of liability based upon the evidence."

Physicians who believe they are victims of identity theft but have not yet suffered any financial liability should call their Medicare administrative contractors or the HHS Office of Inspector General. The OIG hotline is 800-HHS-TIPS.

Without remediation, a physician could be stuck with illegitimate debts after someone else used stolen billing information. The doctor's credit and financial history could be ruined, and he or she could have trouble obtaining loans and running a practice in the future.

Physicians have had problems clearing their names, CMS said in an October letter describing the new program. Medicare has lacked an established protocol for dealing with the consequences of identity theft. Failing to repay bad debts resulting from fraudulent billings could result in collection efforts by the Internal Revenue Service or other federal agencies, CMS said.

The AMA wrote Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder Jr. about the issue in November 2010. Public access to physicians' personal information and billing identification numbers had compromised privacy in recent years. The Association asked the Obama administration to protect physician privacy and ensure that "fewer tax dollars are squandered by fraudulent actors."

"Identity theft can be devastating for physicians -- consuming significant time and financial resources," AMA President Peter W. Carmel, MD, said. "The AMA urged CMS to assist identity theft victims to quickly resolve the issue and avoid financial liability, and we are extremely pleased that CMS has implemented this new streamlined process to provide resources for physicians facing this complicated situation."

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