Patient ID Theft

Patient ID theft is a multifaceted threat to healthcare integrity, occurring both intentionally and occasionally through human error, and poses a tangible danger to patient safety and system accuracy. When a patient ID is stolen, victims may unwittingly receive incorrect treatments, incorrect billing, or find themselves involved in administrative or legal challenges.

Unlike credit card fraud, where consumers are usually shielded from major expenses due to the FCBA (Fair Credit Billing Act), medical identity theft often leaves victims with serious financial burdens. A medical ID theft study reported that 65% of individuals affected by medical fraud reported paying an average of $13,500 out of pocket to resolve the issue. These costs came in different forms—some were forced to reimburse healthcare providers or insurers for services the fraudster received, while others had to hire identity protection services or legal experts to navigate the aftermath and guard against future abuse.

A related concern is the patient ID mismatch—when healthcare systems match individuals with the wrong records due to overlays, duplicate entries, or similar names. Accuracy in matching patients to their electronic records can be as low as 80% in a single institution and decreases to around 50% when sharing data across systems. These errors not only affect care in a negative manner but also result in substantial financial consequences—hospitals spend over $17 million annually in denied claims linked to identification inaccuracies.

So, why do people steal patient IDs? Or use a patient ID that is not theirs? Fraudsters exploit vulnerabilities to gain access to medical care, prescription drugs, or billing systems — often for financial gain. Healthcare data is especially valuable on the black market: medical records sell for an average of $60, while social security numbers sell for only $15 and credit card information for $3. Victims of patient ID theft may receive bills for services they never received, face incorrect diagnoses, or suffer adverse clinical outcomes. Whether due to mistake or intent, patient ID mismatch can result in false medical histories, improper treatments, and denied claims when insurance companies see discrepancies in a patient’s treatment record.

Patient identification technologies and strategies are advancing at a rapid pace to meet the demand of enhanced security and trustworthy authentication. Biometric approaches and multifactor authentication are gaining ground—barcode medication verification, for example, has been shown to reduce medication errors by 74.2%. These technological advancements help reduce denied claims, medical missteps, and the risk of patient ID mismatches.

Imprivata Patient Access, with integrated face authentication and other biometric modalities, represents a forward-looking solution. It strengthens identity boundaries, ensuring that the right patient receives the right care, while also reducing administrative burden and preventing fraudulent or erroneous access to sensitive information by threat actors, or by accident. By deploying access security technology, healthcare providers can mitigate the risks of stolen patient ID misuse and errors to improve patient safety and enhance claim accuracy – which protects patients, safeguards employee productivity, and helps thwart cyber security issues.