Medical Identity Theft: Protecting Your Records and Your Care

What Is Medical Identity Theft?

Medical identity theft occurs when someone uses information such as your name, health insurance ID, Social Security number, or Medicare number to obtain care or submit claims in your name. That could mean a prescription you never filled, equipment you never received, or a visit that appears on your insurance statement even though you weren’t there.

Medicare identity theft is one form of medical identity theft: Someone uses your Medicare number or other identifying information without your permission. Not every incorrect Medicare claim is identity theft; a billing error or a provider’s fraudulent billing can also produce a charge you don’t recognize. Start by checking with the provider, then report an unresolved or suspicious claim.

What makes this theft especially tricky is that it doesn’t just cost money. A thief’s medical history can become tangled with yours in your records, which can affect the care you receive down the road.

How Medical Identity Theft and Medicare Fraud Happen

Thieves have several go-to tactics, and none of them require much technical skill:

• Calls, texts, or emails pretending to be Medicare, a doctor’s office, or an insurer and asking you to “verify” your Medicare number1
• Offers of “free” genetic tests, back braces, or other equipment that require you to hand over your Medicare information
• A data breach involving a provider, pharmacy, or insurer; a breach notice doesn’t mean someone has used your identity, but it’s a reason to watch your claims and accounts more closely
• Stolen mail or a lost or stolen physical Medicare card
• Someone looking over your shoulder at a check-in kiosk or in a waiting room

Remember, if a message creates urgency, contact the organization through a number you found yourself. Our guide to Social Security scams explains similar government-impersonation tactics.

We think the most useful distinction is between how information can be exposed and evidence that it has actually been misused. A suspicious call or breach notice calls for caution; an unfamiliar claim, bill, or medical record calls for a closer investigation.

>> Related Reading: Common Scams That Target Seniors

Warning Signs to Watch For

You don’t have to spot the scam itself to notice that something is wrong. Compare these signs with the care and prescriptions you actually received:

• A bill, Medicare Summary Notice, or insurance Explanation of Benefits showing care, tests, equipment, or prescriptions you didn’t receive
• A call or letter from a provider you don’t recognize about an appointment or balance
• A notice from your plan that a benefit has been used up when your own records don’t account for that use
• A debt collector contacting you about a medical bill you don’t recognize
• An unfamiliar medical collection account on your credit report

An unfamiliar charge can be a billing mistake, so ask the provider about it first. If the explanation doesn’t match the care you received, keep a copy of the statement and follow the reporting steps below.

>> See the Data: Senior Identity Theft Statistics

Why Medical Identity Theft Is Especially Harmful

Unlike a stolen credit card, which you can usually cancel and replace in minutes, medical identity theft can be much harder to untangle. Here’s why it deserves extra attention:

• Financial harm: You may receive bills you don’t owe or need to dispute an unfamiliar medical collection account.
• Health and safety risks: If another person’s diagnoses, allergies, or treatment details become mixed with yours, a clinician could rely on inaccurate information later.
• Coverage problems: A fraudulent claim may complicate your ability to use a benefit or resolve a later claim. The impact depends on your particular plan; Original Medicare doesn’t have a universal annual or lifetime benefit limit.
• Emotional stress: Sorting out billing disputes and medical records can feel overwhelming, especially while also managing your own health.

For caregivers, the helpful role is often a practical one: You can sit together with the older adult, compare statements with an appointment calendar, and help keep a record of calls. If you’ll be speaking to Medicare, an insurer, or a provider on someone else’s behalf, ask what authorization they require first.

>> Medicare Basics: A Senior Guide to Medicare and Medicaid

How to Prevent Medical Identity Theft

The good news is that a few consistent habits go a long way toward keeping your information safe.

Protect Your Information

• Protect your Medicare or Social Security number as carefully as a credit card number. Share it with your doctor, pharmacy, insurer, or an authorized Medicare representative when they need it for your care or coverage. Don’t give it to an unsolicited caller.
• Ask your doctor’s office why they need your Social Security number, and whether an alternative identifier is available.
• Keep insurance cards, medical bills, and prescriptions in a secure place. Shred paper records when you no longer need them, and cover personal details on prescription bottles before recycling them.
• Cover the screen when entering personal information at a check-in kiosk or pharmacy counter.

Be Mindful

• If you have Original Medicare, compare each Medicare Summary Notice for Part A and Part B services with your appointments. If you also have a Part D drug plan, review that plan’s Explanation of Benefits for prescriptions. If you have Medicare Advantage, check the statements and claims information from your plan. Original Medicare generally mails Medicare Summary Notices every six months when claims have been processed, but you can review your claims sooner through your secure Medicare.gov account.
• Create a secure Medicare.gov account to review Original Medicare claims after they’re processed. If you use a Medicare Advantage or drug plan, contact that plan for the most current claim information.
• Don’t give your Medicare number to someone who unexpectedly calls, texts, or emails. Medicare won’t call to sell you something, although a representative may return a call you made or contact you in other limited circumstances.
• Say no to any offer of free medical equipment, screenings, or gifts in exchange for your Medicare information2

What to Do If You Suspect Medical Identity Theft

Start with the charge itself. These steps help you separate an ordinary billing mistake from possible identity theft and keep a record of what you’ve done:

1. Call the provider listed on the bill or claim using a number you found independently. Ask what service was billed and whether it could be a mistake. Contact your insurer or Medicare plan if the charge remains unexplained.
2. If you believe someone has stolen or is using your Medicare number, contact Medicare promptly at 1-800-633-4227, even if you haven’t found a fraudulent claim yet. For free help understanding and reporting suspected Medicare fraud, billing errors, or abuse, call 1-877-808-2468 to connect with the Senior Medicare Patrol (SMP), a federally funded program. If you have Medicare Advantage or Part D, contact your plan about its claim as well.
3. Request the relevant medical records from the providers involved. Review them for visits or details that aren’t yours, and ask the provider in writing to correct inaccurate entries. Under HIPAA, a covered provider generally has 60 days after receiving your amendment request to act on it. The provider may take one extension of up to 30 days if it sends you written notice within the initial 60 days explaining the delay and giving a completion date.3 Keep copies of your request and any responses, and follow up if you haven’t heard back. If a provider denies your request to amend your records, you generally have the right to submit a written statement of disagreement that can be included with the disputed information. If the provider accepts your amendment, you can identify other healthcare organizations that received the incorrect information and need to be notified of the correction.
4. Report the fraud and build a personal recovery plan at IdentityTheft.gov
5. Check your free credit reports at AnnualCreditReport.com for medical collection accounts or other activity you don’t recognize.
6. Keep a written log of every call, letter, and confirmation number for your records

>> Compare Options: Best Identity Theft Protection for Seniors

How an Identity Theft Protection Service Can Help

An identity theft protection service won’t check your Medicare claims or correct a medical chart, so it can’t replace the steps above. However, it can provide an added layer of protection by monitoring for signs that your personal information has been exposed or misused elsewhere, such as alerts involving your Social Security number, financial accounts, or information found on the dark web. We recommend reputable agencies, like Coveron, whose scam protection plan includes dark-web and malware breach alerts.

If you’re comparing services for yourself or a parent, our Coveron and Aura comparison explains the differences in account access, monitoring, and payment terms.

Conclusion

Medical identity theft is worth taking seriously because the problem can extend beyond a bill to your medical history and future care. You don’t need to inspect every piece of paperwork alone: Keep a simple record of the care you receive, ask a trusted caregiver for help if you want it, and question claims that don’t match your records. If something looks wrong, begin with the provider and use Medicare, your plan, and the FTC’s recovery resources to work through the next steps. An identity protection service can add alerts and recovery support, but checking your medical claims remains your most direct safeguard.