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Wednesday, November 19, 2008

HOUSE: Flawed Identity
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** SPOILER ALERT **

Sophia is a factory supervisor who collapses at work and ends up at Princeton-Plainsboro Medical Center. Hmmm...she looks kinda young. Sophia is actually 16 and living on her own - she is a legally emancipated teenager. With both parents deceased the courts recognized her as an adult, giving her personal responsibility and legal authority to make her own decisions. Sophia is found to have acute promyelocytic leukemia and needs a bone marrow transplant from a sibling or parent in order to have the best chance for survival.

There are just a few unresolved problems:
  • Sophia's parents are not dead
  • Sophia is responsible for her sole sibling's death
  • Sophia is not who she says she is, she is an identity thief
It seems 'Sophia' ran away from home out of guilt for her brother's accidental death. She fabricated (embezzled) a new identity and wanted to start over with a clean slate. (Funny...we never learn her real name?!?)

By now most of you are familiar with the serious identity theft problem that threatens every person in this country.
[A quick digression: I love watching the commercials with that CEO blurting out his social security number to boast about his anti-hacker software. How long before he gets burned?]
Anyway, do you know about Medical Identity Theft (MIT)? It is an enormous, underpublicized crisis that is compromising our entire health care system. MIT occurs when someone ineligible for health insurance uses another person's health card for doctor's visits, hospitalizations, prescription drugs, and other medical benefits.

Sophia may have been involved in MIT. Her factory job may not have provided comprehensive health care benefits. The 'real' Sophia's parents [still alive!] would probably need emergency hospitalization when they received the 'Explanation of Benefits' (EOB) from their health insurer - including a $250,000 bill for bone marrow transplantation. Fortunately, Sophia confessed by the end of the program and her real mother and father (still alive!) arrived at her bedside - hopefully with photo IDs.

According to the most recent government statistics approximately 3% of all identity theft cases involve MIT. That's over 250,000 victims per year and countless millions in illegal claims. With traditional identity theft stolen credit cards eventually get canceled and bogus charges are forgiven. Your credit rating remains bruised for awhile as you try to reconcile your accounts. When MIT happens the consequences are far more severe and far more enduring! Huge costs are quickly incurred and everybody ends up paying for the fraudulent claim (insurance premiums, local taxes, higher copays, etc.) Even worse, the victim's computerized medical records are permanently corrupted. Depending on circumstances, it would be very hard to acquire life insurance if your records say you have acute promyelocytic leukemia!

Just like a erroneous credit card charge, if you discover an incorrect billing statement regarding a family member you should fight it, fight it, and fight some more! If you know that the EOB is wrong alert your insurer to the possibility of Medical Identity Theft.

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Posted by: Dr. Lloyd at 11/19/2008 12:00:00 PM

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