How do on-line pharmacies benefit people by distributing medications to people around the globe, and does this alter the dynamics of health-care coverage costs?
I don't know much about the benefits, but on-line pharmacies seem to me allow for the circumvention of national safety laws. It is already an old practice to dump unsafe medication in third world countries and I wouldn't be surprised stuff gets recycled through the internet as well. Stockholders don't care as long as profit is made.
By:Jo Ciavaglia
from: phillyBurbs.com
September 10, 2007 4:49 AM
Daniel Sullivan had a congenital heart condition, but no health insurance. A guy he knew had health coverage, and no history of heart problems.
So Sullivan stole the acquaintance's benefits information and pretended to be him, racking up more than $146,000 in hospital bills over seven months before he was caught.
The Sullivan case was one of the first U.S. documented case of medical ID theft, one of the most elusive, fastest growing, but least studied or documented subgroup of identity theft crimes, legal and privacy experts say.
“Think of it as a Visa card with a million-dollar limit,” said Nils Frederiksen, spokesman for the Pennsylvania Attorney General's Office, which filed criminal charges against Sullivan, of Philadelphia, in 2005.
Scarier still is that it can take years before someone realizes that medical benefits information has been stolen, and once it's discovered, false health entries never can be completely erased from medical records.
No reliable statistics exist for medical identity theft, but the number of Americans identifying themselves as victims in government documents nearly tripled in four years to more than a quarter-million in 2005, according to law enforcement.
The Philadelphia region's top health insurers — Independence Blue Cross and Aetna — have seen fraud investigations involving medical ID theft double recently, though they say it's still a small percentage of overall cases.
There is limited public awareness of medical identity theft, which is where public awareness of financial identity theft was 15 years ago, said Pam Dixon, executive director of the World Privacy Forum. The California research and advocacy group last year released the first, and only, comprehensive report on medical identity theft.
There are no federal statistics or studies on the prevalence of medical identity theft. The Federal Trade Commission started recording medical identity theft complaints in 1992, and it logged 19,428 complaints as of May 2006. Roughly one-quarter of the complaints — 4,500 — were filed in 2006.
Based on its research, the World Privacy Forum estimates at least a half million Americans are victims and most probably don't know it.
“We feel that is an extremely conservative number,” Dixon added. “This is an almost impossible crime to detect.”
INSIDE INFO
Five Pennsylvania and New Jersey hospitals treated Daniel Sullivan in 2003, but his scheme disintegrated only after his health insurer, Aetna, contacted the man Sullivan was impersonating to confirm the medical treatment he had received, according to criminal charges.
The Sullivan case is one of two medical identity theft criminal cases the Pennsylvania Attorney General's Office has pursued in the last two years, Frederiksen said. He said his office is investigating a third possible case.
In July 2006, Sullivan pleaded guilty to charges that included theft by deception, insurance fraud and identity theft. He was sentenced to three to six years in prison.
Later that month, the attorney general filed fraud, identity theft and related charges against Galen Baker, also of Philadelphia, who was accused of stealing a co-worker's name and insurance information to buy more than $3,000 in forged Viagra prescriptions.
Between 2004 and 2005, Baker illegally obtained 38 prescriptions for the drug that treats erectile dysfunction. He got caught after a pharmacist contacted the victim about a prescription and was told he didn't order it. Last year, Baker pleaded guilty to one count of insurance fraud and received two years of probation, community service and restitution.
The Sullivan and Baker cases are considered lower-end medical ID theft schemes, privacy experts said.
Most thieves don't steal benefits information for their own use, but rather sell the data to a third party, who files false insurance claims, said Dixon, of the World Privacy Forum.
Overwhelmingly, medical identity theft is perpetrated by people with legitimate access to medical and insurance billing information, including doctors, clinics, billing specialists, nurses, office administrators, Dixon explained.
These “insider” health system workers copy patient information and sell it, or to use that information to help provide victims for bigger, more organized medical identity theft schemes, she continued. The insider will alter patient medical files and diagnoses to reflect phony medical care. The insurance payments are then typically forwarded to a different address.
Doctors can be victims, too. Thieves steal a doctor's name, license number, forge a signature, falsify patient records, and forge prescriptions. This type of medical identity theft is often the starting point for spreading incorrect patient information, and it is often seen when professional crime rings are involved, according to the privacy forum.
Sophisticated fraud rings can collect $1 million to $2 million in less than a year before someone catches on and the larger the medical provider, the easier thieves can avoid detection, Dixon added.
“This kind of information is worth so much more money than standard financial information at this point,” she added. “It hides extremely well. It's a perfect storm of fraud.”
FINDING FRAUD
Medical identity theft is not typically detected by traditional reporting methods associated with financial identity theft. For example, victims may never have their credit cards or credit score affected by this crime.
Insurance companies review databases and check bills for legitimacy, but with millions of claims processed each year, they rely heavily on members to bring suspicious information to their attention, said Mike Stergio, head of special investigations for Aetna.
Among its preventative steps, Aetna has stopped sending provider payments to billing addresses with a post office box — a common way that scammers avoid detection. The company now requires a legitimate street address, Stergio said.
The Philadelphia region's largest insurer, Independence Blue Cross, has data-mining software and a specialized computer program that reviews claims data for inconsistencies and unusual billing patterns, spokeswoman Ruth Stoolman said.
Blue Cross estimates that 30 of the 67 suspected fraud cases it referred to law enforcement this year involving medical identity theft included people who knowingly let someone else use their medical benefits, Stoolman said.
The previous two years, ID theft represented fewer than 10 fraud cases, Stoolman added.
This year, Aetna anticipates more than doubling fraud investigations involving medical ID theft nationwide. Last year, it investigated 26 suspected cases, spokesman Walt Cherniak said.
Among Aetna's current investigations is a suspected ring that recently billed the insurer more than $2 million in phony medical services, Stergio said.
He couldn't provide many details about the case, which involves 338 customers in a Southern state with one common denominator: They were all patients at the same medical practice between April and May. Federal investigators believe patients' information was stolen from the practice, he said.
After 25 customers alerted Aetna that their “explanation of benefits” notice included unfamiliar services and healthcare providers, the insurer contacted the other customers it received bills for and learned they hadn't been treated either for the billed procedures, Stergio said.
Had the customers not contacted Aetna, it's likely the fraud wouldn't have been detected anytime soon, Stergio said.
The Federal Trade Commission Identity Theft Site at www.ftc.gov
Preventing medical identity theft
Review all “Explanation of Benefits” notices and any other correspondence from your insurer describing the services you have received, the provider charges and payment allowances. Report suspicious transactions to your health insurer's special investigations unit.
Request a complete list of annual payments your insurance company has made for your medical care. Sometimes, thieves change your billing address and phone number, which means you may not see all your bills.
Get a copy of your medical records, in case they're tampered with in the future.
Keep track of your medical and prescription benefits cards and keep them in a safe place.
Think you're a victim of medical identity theft?
Request an annual accounting of disclosures from healthcare providers and insurers
This record shows what information was disclosed, when it was disclosed, why it was disclosed, and who received the information. Under the HIPAA federal health privacy rule, you have a right to a copy of the account of disclosures of your records made by healthcare providers and insurers.
Request a copy of current medical files from each healthcare provider
Make requests for doctor, hospital, pharmacy and lab records. If a healthcare provider refuses, appeal the denial. The provider's privacy policy explains the appeal procedure. You're entitled to a free copy of the provider's notice of privacy practices upon request.
If you're not satisfied, file a complaint with the Office of Civil Rights at the federal Department of Health and Human Services at www.hhs.gov or 1-800-368-1019.
Correct erroneous and false information in your file
If you find information that's not about you, demand that it be removed from the record.
Keep an eye on your credit report
Victims often find a collection notice from a hospital, medical lab or for a variety of medical services they didn't get on their credit *eports. Dispute these collection notice(s) right away.
Removing incorrect information from medical records
Don't forget to get wrong information removed from copies of medical records filed with insurers, laboratories, pharmacies and hospitals.
When a record is corrected, that record keeper has an obligation under the federal health privacy rule to inform o*hers to whom it disclosed the original (wrong) information. Ask each of the other record keepers if the corrections were received and entered properly in your record.
Report the theft of your health insurance card to your insurer and police. Obtain a copy of the police report. Sending copies of the police report to insurers, providers and credit bureaus may be a step toward cleaning up the problem.
Doctors and hospitals are often reluctant to remove wrong information from health records. Sometimes, if action was taken on the basis of erroneous information, the wrong information is needed to explain why that action was taken. The usual remedy is to keep the erroneous information and indicate why it is wrong.
I've heard a lot of people taking Ritalin for it's speed-effect. I think there was even an episode of Desperate Housewives on that very topic, where one of the mothers was taking the kids ritalin for her own use. [see: episode ]
Anyway, it makes sense this would be a concern because speed is addictive. After a while, 1 or 2 pills aren't enough, a person has to get more. If a person has a credit card and a computer, and there are internet services that deliver, imagine the debt!
HOLY CRAP!
What happens when ritalin isn't enough? Or the credit card reaches it's limit? That's when the real trouble begins.
The same can be said about narcotic pain pills, too.
Holy crapaholic!
Who ever came-up with the idea of putting a pharmacy on-line???
Were they insane???
Of course people could lie and cheat!
Look what they did to create families, for an entire era before this computer generation!! They started it by stealing babies, falsifying documents, and claiming the official records are "sealed".
What time is it? I need my morning dose of SOMETHING!
Comments
Safety
I don't know much about the benefits, but on-line pharmacies seem to me allow for the circumvention of national safety laws. It is already an old practice to dump unsafe medication in third world countries and I wouldn't be surprised stuff gets recycled through the internet as well. Stockholders don't care as long as profit is made.
Thieves stealing health care
By:Jo Ciavaglia
from: phillyBurbs.com
September 10, 2007 4:49 AM
Daniel Sullivan had a congenital heart condition, but no health insurance. A guy he knew had health coverage, and no history of heart problems.
So Sullivan stole the acquaintance's benefits information and pretended to be him, racking up more than $146,000 in hospital bills over seven months before he was caught.
The Sullivan case was one of the first U.S. documented case of medical ID theft, one of the most elusive, fastest growing, but least studied or documented subgroup of identity theft crimes, legal and privacy experts say.
“Think of it as a Visa card with a million-dollar limit,” said Nils Frederiksen, spokesman for the Pennsylvania Attorney General's Office, which filed criminal charges against Sullivan, of Philadelphia, in 2005.
Scarier still is that it can take years before someone realizes that medical benefits information has been stolen, and once it's discovered, false health entries never can be completely erased from medical records.
No reliable statistics exist for medical identity theft, but the number of Americans identifying themselves as victims in government documents nearly tripled in four years to more than a quarter-million in 2005, according to law enforcement.
The Philadelphia region's top health insurers — Independence Blue Cross and Aetna — have seen fraud investigations involving medical ID theft double recently, though they say it's still a small percentage of overall cases.
There is limited public awareness of medical identity theft, which is where public awareness of financial identity theft was 15 years ago, said Pam Dixon, executive director of the World Privacy Forum. The California research and advocacy group last year released the first, and only, comprehensive report on medical identity theft.
There are no federal statistics or studies on the prevalence of medical identity theft. The Federal Trade Commission started recording medical identity theft complaints in 1992, and it logged 19,428 complaints as of May 2006. Roughly one-quarter of the complaints — 4,500 — were filed in 2006.
Based on its research, the World Privacy Forum estimates at least a half million Americans are victims and most probably don't know it.
“We feel that is an extremely conservative number,” Dixon added. “This is an almost impossible crime to detect.”
INSIDE INFO
Five Pennsylvania and New Jersey hospitals treated Daniel Sullivan in 2003, but his scheme disintegrated only after his health insurer, Aetna, contacted the man Sullivan was impersonating to confirm the medical treatment he had received, according to criminal charges.
The Sullivan case is one of two medical identity theft criminal cases the Pennsylvania Attorney General's Office has pursued in the last two years, Frederiksen said. He said his office is investigating a third possible case.
In July 2006, Sullivan pleaded guilty to charges that included theft by deception, insurance fraud and identity theft. He was sentenced to three to six years in prison.
Later that month, the attorney general filed fraud, identity theft and related charges against Galen Baker, also of Philadelphia, who was accused of stealing a co-worker's name and insurance information to buy more than $3,000 in forged Viagra prescriptions.
Between 2004 and 2005, Baker illegally obtained 38 prescriptions for the drug that treats erectile dysfunction. He got caught after a pharmacist contacted the victim about a prescription and was told he didn't order it. Last year, Baker pleaded guilty to one count of insurance fraud and received two years of probation, community service and restitution.
The Sullivan and Baker cases are considered lower-end medical ID theft schemes, privacy experts said.
Most thieves don't steal benefits information for their own use, but rather sell the data to a third party, who files false insurance claims, said Dixon, of the World Privacy Forum.
Overwhelmingly, medical identity theft is perpetrated by people with legitimate access to medical and insurance billing information, including doctors, clinics, billing specialists, nurses, office administrators, Dixon explained.
These “insider” health system workers copy patient information and sell it, or to use that information to help provide victims for bigger, more organized medical identity theft schemes, she continued. The insider will alter patient medical files and diagnoses to reflect phony medical care. The insurance payments are then typically forwarded to a different address.
Doctors can be victims, too. Thieves steal a doctor's name, license number, forge a signature, falsify patient records, and forge prescriptions. This type of medical identity theft is often the starting point for spreading incorrect patient information, and it is often seen when professional crime rings are involved, according to the privacy forum.
Sophisticated fraud rings can collect $1 million to $2 million in less than a year before someone catches on and the larger the medical provider, the easier thieves can avoid detection, Dixon added.
“This kind of information is worth so much more money than standard financial information at this point,” she added. “It hides extremely well. It's a perfect storm of fraud.”
FINDING FRAUD
Medical identity theft is not typically detected by traditional reporting methods associated with financial identity theft. For example, victims may never have their credit cards or credit score affected by this crime.
Insurance companies review databases and check bills for legitimacy, but with millions of claims processed each year, they rely heavily on members to bring suspicious information to their attention, said Mike Stergio, head of special investigations for Aetna.
Among its preventative steps, Aetna has stopped sending provider payments to billing addresses with a post office box — a common way that scammers avoid detection. The company now requires a legitimate street address, Stergio said.
The Philadelphia region's largest insurer, Independence Blue Cross, has data-mining software and a specialized computer program that reviews claims data for inconsistencies and unusual billing patterns, spokeswoman Ruth Stoolman said.
Blue Cross estimates that 30 of the 67 suspected fraud cases it referred to law enforcement this year involving medical identity theft included people who knowingly let someone else use their medical benefits, Stoolman said.
The previous two years, ID theft represented fewer than 10 fraud cases, Stoolman added.
This year, Aetna anticipates more than doubling fraud investigations involving medical ID theft nationwide. Last year, it investigated 26 suspected cases, spokesman Walt Cherniak said.
Among Aetna's current investigations is a suspected ring that recently billed the insurer more than $2 million in phony medical services, Stergio said.
He couldn't provide many details about the case, which involves 338 customers in a Southern state with one common denominator: They were all patients at the same medical practice between April and May. Federal investigators believe patients' information was stolen from the practice, he said.
After 25 customers alerted Aetna that their “explanation of benefits” notice included unfamiliar services and healthcare providers, the insurer contacted the other customers it received bills for and learned they hadn't been treated either for the billed procedures, Stergio said.
Had the customers not contacted Aetna, it's likely the fraud wouldn't have been detected anytime soon, Stergio said.
FYI
Preventing medical identity theft
Think you're a victim of medical identity theft?
Request an annual accounting of disclosures from healthcare providers and insurers
This record shows what information was disclosed, when it was disclosed, why it was disclosed, and who received the information. Under the HIPAA federal health privacy rule, you have a right to a copy of the account of disclosures of your records made by healthcare providers and insurers.
Request a copy of current medical files from each healthcare provider
Make requests for doctor, hospital, pharmacy and lab records. If a healthcare provider refuses, appeal the denial. The provider's privacy policy explains the appeal procedure. You're entitled to a free copy of the provider's notice of privacy practices upon request.
If you're not satisfied, file a complaint with the Office of Civil Rights at the federal Department of Health and Human Services at www.hhs.gov or 1-800-368-1019.
Correct erroneous and false information in your file
If you find information that's not about you, demand that it be removed from the record.
Keep an eye on your credit report
Victims often find a collection notice from a hospital, medical lab or for a variety of medical services they didn't get on their credit *eports. Dispute these collection notice(s) right away.
Removing incorrect information from medical records
Don't forget to get wrong information removed from copies of medical records filed with insurers, laboratories, pharmacies and hospitals.
When a record is corrected, that record keeper has an obligation under the federal health privacy rule to inform o*hers to whom it disclosed the original (wrong) information. Ask each of the other record keepers if the corrections were received and entered properly in your record.
Report the theft of your health insurance card to your insurer and police. Obtain a copy of the police report. Sending copies of the police report to insurers, providers and credit bureaus may be a step toward cleaning up the problem.
Doctors and hospitals are often reluctant to remove wrong information from health records. Sometimes, if action was taken on the basis of erroneous information, the wrong information is needed to explain why that action was taken. The usual remedy is to keep the erroneous information and indicate why it is wrong.
Source: World Privacy Forum
Jo Ciavaglia can be reached
at 215 949-4181
or jciavaglia@phillyBurbs.com<.
ritalin
I've heard a lot of people taking Ritalin for it's speed-effect. I think there was even an episode of Desperate Housewives on that very topic, where one of the mothers was taking the kids ritalin for her own use. [see: episode ]
Anyway, it makes sense this would be a concern because speed is addictive. After a while, 1 or 2 pills aren't enough, a person has to get more. If a person has a credit card and a computer, and there are internet services that deliver, imagine the debt!
HOLY CRAP!
What happens when ritalin isn't enough? Or the credit card reaches it's limit? That's when the real trouble begins.
The same can be said about narcotic pain pills, too.
Holy crapaholic!
Who ever came-up with the idea of putting a pharmacy on-line???
Were they insane???
Of course people could lie and cheat!
Look what they did to create families, for an entire era before this computer generation!! They started it by stealing babies, falsifying documents, and claiming the official records are "sealed".
What time is it? I need my morning dose of SOMETHING!