Beware of Physician Identity Theft

An increase in physician identity theft is being seen. The stolen physician identities are used to establish provider numbers
and bill Medicare fraudulently. Two scenarios have been identified. In one scenario, individuals are soliciting personal
identification information from physicians by posing as a Medicare Carrier.  In one instance, a provider received a fax on what
appeared to be the Carrier’s letterhead. The fax was labeled “CMS File Update” and asked for a series of documents, including
copies of the physician’s medical license and driver’s license. The physician faxed the requested information to a toll-free
“877” number. The unknown party then submitted a Medicare provider application (CMS 855) under the provider’s name and
set up a ‘fake’ office in another city. The real physician discovered the fraud when a third party insurer contacted him for a refund on
a patient that was not his. In another scenario, a physician learned his identity may have been stolen as a result of submitting
his personal information in response to employment ads. Once the personal information is obtained, fraudulent applications
are submitted to Medicare and provider numbers are obtained for new practice locations. Once the new provider number is
established, these individuals are rapidly submitting a large volume of fraudulent claims to the Medicare Carrier for payment.
Protect Your Identity!
If you have recently received a phone call or fax from an alleged Contractor Employee asking for a “CMS File Update”, please
contact the provider enrollment department immediately for verification. If you are responding to employment ads, please verify
who you are corresponding with before you send personal information.
Remember, it takes all of us working together to protect the Medicare Trust Fund.