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Identity crisis: Protect yourself from ID theft

You can make yourself less of a tantalizing target for an information thief.

By Tyler Chin, amednews staff. Oct. 13, 2003.

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Jonathan L. Pollitte, MD, an internist in Johnson City, Tenn., was terrified that his medical career would be derailed just as it was being launched.

Unknown to Dr. Pollitte, a former employer had obtained a unique physician/practitioner identification number under his name and used it to submit more than $2 million in bogus claims to Medicare.

Dr. Pollitte eventually convinced federal investigators he was innocent, but not before losing 20 pounds in 15 days because he was so anxious and stressed out about his career and family's future, said Bruce Shine, the Knoxville, Tenn., attorney who represented him.

Dr. Pollitte was among the estimated 9.9 million Americans who were victimized by some form of identity theft last year, according to a survey released Sept. 3 by the Federal Trade Commission. That survey figure was higher than two other estimates by Gartner Inc. and Harris Interactive Inc., which in July pegged the number of victims within the previous 12 months at 7 million.

Identity theft occurs when crooks misuse someone else's personal information for their own gain. That includes obtaining bank accounts, credit cards, loans, utilities, mortgages and merchandise under that person's name. The crime can ruin victims' finances, credit ratings and reputations, and exact a heavy emotional toll as victims go through an often-frustrating and time-consuming process to clear their names, experts say.

In 2002, the crime cost businesses and consumers $53 billion, the FTC survey found. Because people's personal information is so readily available, identity theft cannot be prevented entirely. But physicians can reduce the risk of being victimized by being careful about how they manage sensitive information such as Social Security numbers and birth dates, said Betsy Broder, assistant director in the FTC's division of planning and information.

Crooks usually steal information through low-tech methods: swiping wallets, purses and mail, and "dumpster diving," or rummaging through trash, she said. But identity thieves can also steal information online.

Criminals, of course, constantly attempt to hack into the computer networks of financial and health care organizations. But now they're increasingly "phishing" for individual information. Con artists cast their nets by posing as well-known corporations and sending logo-studded, official-looking e-mail to would-be victims, urging them to update their account information by clicking on a hyperlink, which goes to a look-alike Web page.

Insider info

But most identity thefts are inside jobs. They are committed by dishonest people in trusted positions in a physician office, hospital, company, government agency or other entity with access to people's personal information, Broder said.

That is how Dr. Pollitte's identity was stolen after he joined Accumed Medical Services Corp., which had hired him part-time to perform screenings related to life and disability insurance policies.

Dr. Pollitte was out of the country at press time and could not be reached for comment. He learned he was under investigation when he received two telephone calls within days of each other last year, according to his attorney, Shine.

Shortly after a private insurer inquired about some claims he allegedly had submitted, the U.S. Dept. of Health and Human Services asked Dr. Pollitte to explain more than $2 million in billings to Medicare.

Dr. Pollitte told the insurer and investigators from HHS and the Federal Bureau of Investigation that he did not file the claims and had not treated the patients associated with them, Shine said. But it took a while for officials to come around because they suspected Dr. Pollitte of "trying to make a killing to pay off" his medical school debt, Shine said.

To prove his innocence, Dr. Pollitte wore a wire and turned over all of his financial records so authorities wouldn't think he was hiding something, Shine said. "The first thing doctors ought to do in this sort of instance is to totally cooperate with law enforcement."

On Feb. 27, the federal government filed criminal charges against Craig Robert Lodge, who owned Accumed with his wife, Mailee Renae Lodge. Craig Lodge pleaded guilty April 28 to stealing the identity of Dr. Pollitte to fraudulently bill Medicare for more than $2 million from September 2000 through January 2003. Half of that was paid out to Accumed before the fraud was discovered, according to Lodge's plea agreement with prosecutors. He also admitted stealing Dr. Pollitte's identity to obtain controlled substances and falsely bill private insurers for $52,000.

Lodge also admitted stealing the identities of two other Johnson City physicians -- Asa A. Peek, DO, who until this year was an obstetrics-gynecology resident at a local hospital, and Guha Krishnaswamy, MD, an internist. Lodge used the physicians' names to obtain loans to buy a 45-foot powerboat for $249,000, and lease a Mercedes Benz and a sports utility vehicle.

Lodge is awaiting sentencing, pending the trial of his wife. She was indicted May 13 on 14 counts of Medicare and other fraud. Her trial is scheduled to start Oct. 29.

Protecting yourself

While physicians aren't at greater risk than anyone else for having their identities stolen, they are appealing and vulnerable targets to crooks familiar with the industry's billing and payment practices, said Bill Mahon, CEO and president of the Washington, D.C.-based National Health Care Anti-Fraud Assn, a nonprofit group made up of health insurers and governmental authorities responsible for policing health insurance fraud.

"The problem isn't rampant, but it's significant," Mahon said. "Physicians just need to be watchful for anything that seems out of the ordinary in terms of their financial transactions."

Physicians may appeal to some criminals with poor credit histories because they know companies view doctors as good credit risks, believes Neil Smith, the assistant U.S. attorney prosecuting Lodge.

But short of catching a lucky break and implementing good internal controls, there isn't much physicians can do that would allow them to realize that their identity has been hijacked before HHS, the Internal Revenue Service or collection agencies come knocking, he said.

One thing they can do, however, Mahon suggested, is ask patients to report receiving any insurance company explanation of benefits forms for services that were never performed.

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