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How to check your medical records for mistakes, fraud and abuse

In the age of COVID-19, fraud is rampant. It’s not just phishing and identity theft running wild, but healthcare fraud as well. In July alone, the FBI indicted a laboratory group, a dentist and a nurse practitioner for billing fraud and prescription conspiracies.

In times of fear and uncertainty, hackers are hard at work trying to con people looking for help or information. Tap or click here to see how fake COVID-19 tests are leading to identity theft.

Just like keeping an eye on your credit score to prevent financial fraud, there exists a hidden score that health agencies use to assess your risk factor. This hidden “health credit report” is based on your medical records and determines your eligibility for insurance and coverage. Here’s how you can check yours for mistakes and any signs of fraud.

How to monitor your health credit report

Life insurance companies use your health credit report to determine how big of a risk you are. These reports give a readout of your overall health history and include details like pre-existing conditions and what prescription medications you’ve taken over the course of your life.

Insurance companies don’t compile these reports themselves. Instead, they rely on third-party companies to gather information on people applying for insurance — similar to how credit bureaus operate. Once this information is prepared, the report is sold to the insurance company that requests it.

But just like financial credit reports, health credit reports can also contain mistakes that accumulate over time. It’s a good idea to check your report from time to time to make sure everything looks normal.

You have the right to see your report whenever you’d like. And if you find errors like incorrect prescription history or inaccurate spellings of your name and address, you can correct these issues and potentially save money on your policy.

This is also where you’re likely to find signs of fraud and abuse, such as insurance claims made or hospital stays taken in your name.

Here are three of the top health credit report companies and how to contact them to learn about your information.

Milliman IntelliScript

Milliman IntelliScript has prescription information about you if you’ve authorized the release of your medical records to an insurance company and that company requests a report. To see your report, tap or click here to visit Milliman Intelliscript’s official website. Be ready to provide the following information:

  • Full name
  • Mailing address (and email address if you’d like to receive your report via email)
  • Your phone number (in case the company needs to call you with questions)
  • Date of birth
  • Last four digits of your Social Security number
  • The insurance company that you have applied with

ExamOne

ExamOne is a Quest Diagnostics company, which means it has access to lab tests conducted by Quest Diagnostics and others for you over the years. Using this data, it compiles reports to assess your risk factor for insurance providers.

To contact ExamOne and get your report, call 1-877-933-9261 or fill out the contact form here. You can request either a health report or lab result report.

MIB Group

MIB Group was formerly known as the Medical Information Bureau. It tracks everyone who applies for individually underwritten life, health or disability income insurance during the previous seven years.

To get a look at what’s in your MIB report, call 866-692-6901. You will be asked a number of personal questions to help the phone agent access your file. MIB’s support hours are from 6 to 12 a.m. Eastern Standard Time.

Alternatively, you can tap or click here to fill out an application for your report online.

It may take up to 10 business days to receive your report. The good news is the reports are free. We recommend looking at them even if you’re not applying for life insurance just to make sure there are no mistakes or evidence of fraud.

These agencies aren’t the only ones keeping tabs on your medical records. Tap or click here to see why Google has access to millions of Americans’ health data.

Getting records from your doctors or healthcare providers

Per HIPAA, the Health Insurance Portability and Accountability Act, all patients have the right to access their medical records and medical bills from care providers. This includes:

  • Notes or records created by your provider.
  • Diagnostic results a provider has copies of, including biopsies, blood tests, genetic tests, mammograms and X-rays.
  • Information provided by another doctor used to give a diagnosis and/or direct medical treatment.

Requests for psychotherapy notes or medical information compiled for lawsuit purposes may be denied.

To obtain your records, most facilities or providers will have you fill out a form with personal details like your name, Social Security number, address and date of birth. Contact the doctor, practice or hospital you wish to obtain records from and ask about a “record request form.” Usually, the front office can email it or fax it to you to fill out and return by mail.

You may also be asked to pay a processing fee for your records, so don’t be surprised if this comes up.

If your doctor is no longer in practice or the facility you received care at no longer exists, contact your health insurance provider. They may be able to locate the records through alternative means or potentially locate your former care provider for more information.

Correcting the record

Now that you’ve seen your “health credit report” and medical records, it’s time to review them. Keep an eye out for inaccuracies that could drive up your insurance rates, like these:

  • Errors in the spelling of your name. This can prevent your records from being exchanged between different providers.
  • Incorrectly typed phone numbers, addresses and contact information. This can result in billing errors.
  • Inaccurate data regarding your medical conditions, symptoms, diagnosis or treatment plans. Fraudulent or incorrectly labeled conditions can give the impression of higher risk status.

Information that is less urgent to correct includes misspellings of diagnoses and conditions and inaccurate appointment times. So long as appointment dates and times are mostly accurate, these corrections are of less immediate concern.

Requesting the fix

The next step is to contact the healthcare provider, hospital or insurance company involved in the inaccurate entries to ask if they offer forms to make amendments to your records. You can usually request these sent to you by mail or digitally by email or fax.

Be clear, concise and write the correction exactly as you think it should be noted. The idea is to make it very easy for your provider’s office to amend your records.

Make copies of the pages where you find inaccuracies, and on the page where you’re showing the correction, strike through the inaccurate segments with a pen. Fill out any additional forms required by your insurance company or hospital and attach the corrections to them when you send it back by mail or digitally.

More complex amendments (such as for fraud) may require a written letter explaining the circumstances in greater detail.

Can my request be denied?

Providers and hospitals must respond to your request within 60 days, but that doesn’t mean they’ll always make the changes you request. Legally, they’re not required to, but they must explain why if they choose not to do so.

If your request is denied, it’s usually because removing an entry would have an adverse effect on your well-being or future treatment options.

It’s amazing how much data is collected about you without you realizing it. If you think medical agencies collected a hefty amount of info, they have nothing on search engines. Tap or click here to find out how to delete everything that Google knows about you.

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