How to Avoid Medical Identity Theft

What Is Medical Identity Theft?

Medical identity theft is a type of identity theft that occurs when a thief uses your name, Social Security number, health insurance policy number or Medicare number to obtain medical services or products.

The damage can show up on your insurance statements, your credit report or even inside your medical file. Medical identity theft can take several forms, including:

• Fraudulent medical care: Someone uses your details to see a doctor, get lab work or have procedures done and bills your insurance.
• Prescription fraud: A thief uses your information to get prescription drugs or medical equipment.
• Fake insurance claims: A dishonest provider or individual submits claims to your insurance for services you never received.

Any of these scenarios can also lead to mixed-up medical records, where the thief's health history ends up blended with yours. That's part of what makes medical identity theft uniquely damaging. Beyond the financial fallout, inaccurate information in your file can affect the care you receive down the road.

Be aware: A jumbled medical record resulting from medical identity theft isn't just a paperwork issue. Incorrect blood type, allergy or medication details in your file can directly affect the care you receive in an emergency.

How Does Medical Identity Theft Happen?

Medical identity theft can happen in several ways, and the thief isn't always a stranger. Common causes include:

• Physical theft: A lost or stolen wallet, insurance card or mailed statement can give someone access to your health information. Discarded medical paperwork pulled from the trash is another risk.
• Friendly fraud: A family member or friend uses your insurance to get care they can't afford or don't qualify for.
• Health care data breaches: Hackers frequently target hospitals, health plans and their vendors. In 2025, some 710 health care data breaches affecting 500 or more people were reported to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights, exposing the health information of more than 61 million individuals, according to the HIPAA Journal's analysis of HHS data.
• Phishing scams: Using fake calls, texts or emails, scammers may pose as insurers, Medicare personnel or health care providers to trick you into sharing personal details. Offers of free medical equipment, genetic testing or services are another warning sign.

Signs of Medical Identity Theft

Medical identity theft often goes unnoticed for months, so it's important to watch out for these red flags:

• Unfamiliar bills or explanation of benefits (EOB) statements: EOBs are often the first place fraud shows up, so read them carefully instead of filing them away. Watch for charges tied to appointments, procedures or prescriptions you never had.
• Collection notices: If a debt collector contacts you about a medical bill you don't recognize, don't brush it off. Even small, unfamiliar charges are worth investigating since the bill had to originate somewhere, likely from a provider visit tied to your information.
• Credit report surprises: Medical collections from providers you've never visited are a strong warning sign. Regularly monitoring your credit reports can help you spot accounts that don't belong to you.
• Insurance limits hit unexpectedly: If your insurer says you've reached a benefit cap or lifetime limit that doesn't match your actual care, it's worth a closer look. This can happen when a thief uses your coverage for their own treatments or prescriptions.
• Errors in your medical records: Diagnoses, test results, procedures or medications that don't belong to you are another clear sign that someone else's care has ended up in your file. You can spot these by requesting your records from your providers or checking your patient portal.

How to Avoid Medical Identity Theft

You can't eliminate every risk, but these habits can go a long way toward protecting your health information:

• Guard your physical documents. Keep insurance cards, prescriptions and billing statements in a safe place, and shred anything with medical or personal details before tossing it.
• Be stingy with your Social Security number. Ask providers if they can use a different identifier or just the last four digits.
• Review every EOB and medical bill. Match the dates, providers and services to the care you actually received. You may even be able to turn on claim alerts in your insurer's patient portal. That way, you'll see new activity quickly.
• Request your medical records. Check for visits, diagnoses or prescriptions that don't belong and keep copies for your own records.
• Use strong, unique passwords. Protect online patient portals and insurance accounts with a password manager and multifactor authentication.
• Ignore unsolicited outreach. Don't share medical details with anyone who calls, emails or texts you out of the blue. Log in directly or call a number you trust.
• Monitor your credit. Unpaid medical bills over $500 that end up in collections can appear on your credit reports and hurt your credit scores. You can get your free credit report from Experian and make sure you recognize everything on it.

Learn more: Ways to Protect Yourself from Identity Theft

What to Do if You Think You're a Victim of Medical Identity Theft

Some people think their health plan will automatically catch and reverse fraudulent claims. In reality, insurers often pay claims without detecting fraud, and it's up to you to request records, flag errors and push for corrections.

If something looks off, act quickly. The longer fraud sits uncorrected, the harder it is to untangle. Here are the steps you can take to get the help you need:

1. Report the theft. File a report at IdentityTheft.gov to get an official Identity Theft Report and a personal recovery plan.
2. Consider filing a police report. Local police reports can help when you're disputing charges or working with providers.
3. Notify your insurer. Call the fraud department of your health plan and ask for a list of benefits paid in your name.
4. Request your medical records. Contact every provider, pharmacy and lab the thief may have used. You may need to submit a written request or pay a copy fee.
5. Dispute errors in writing. Send corrections to each health care provider by certified mail with a copy of your identity theft report. Medical providers must respond within 30 days and notify other providers who may share the same mistake.
6. Add a fraud alert or credit freeze. You have the right to add a fraud alert or credit freeze to your credit reports, which makes it harder for thieves with your information to open credit accounts in your name.
7. Review your credit reports. Check your credit reports from all three credit bureaus (Experian, TransUnion and Equifax) carefully to ensure no collection accounts related to the medical identity theft appear there. If they do, you have the right to dispute them.
8. Continue monitoring. Check your credit reports and EOBs regularly for months afterward, since fraud can resurface.

The Bottom Line

Medical identity theft can affect both your wallet and your well-being, but staying alert goes a long way. Review your medical statements, keep personal information locked down and act fast if something doesn't add up.

Regular credit monitoring can help you catch the financial side of medical fraud early. Experian's free credit monitoring alerts you to new accounts, inquiries and other changes on your Experian credit report, so you're not the last to know when someone is using your identity.