Identity Theft in Long-Term Care

There are resources available to help prevent wrongdoers from successfully targeting vulnerable patient populations.

A dirty little secret of the long-term care industry is that the problem of identity theft arises more often than is reported. 

In all fraud, there is the fraud triangle. The triangle sides are pressure, opportunity, and rationalization.  

Let’s start with pressure. Minimum wages have not increased since 2009. Most of the nurses and aides working in long-term care are paid minimum wage. Additionally, most long-term care providers offer little in the way of benefits.

The opportunity is huge. You have 100 or more people who usually have stopped filing taxes or checking their credit reports. Caregivers have patients’ names and birthdates, at a minimum, from medical records. Mail and visits from relatives can provide other information like Social Security numbers. 

There is a cottage industry of dishonest tax preparation services that can easily file fraudulent returns and have refunds sent to criminals.

One interesting spin on identity theft is the use of the victim’s insurance benefits. Under this scam, the thief uses the elderly patient’s Medicare card to get medical benefits under the Medicare and Medicaid programs.

The rationalization makes this scarier. The criminals think to themselves that the Internal Revenue Service (IRS) will never make these old people pay back the money from the filing of fraudulent tax returns, and credit card companies will simply write off the balances. If they use the victim’s insurance benefits, they think, Medicare and Medicaid can afford to cover the loss.  

They also may feel that elderly nursing-home patients will never be seriously impacted by low credit scores.

Here is something that shocked me, though. As mentioned, identity theft in long-term care institutions is much more common than is reported. 

What can you do if you have a loved one in a nursing home or other long-term care facility? Review the medical benefit letters of your loved ones. Questionable charges? Contact your healthcare provider first to see if it’s a mistake. If your issue is not resolved by your provider, report the questionable charges to 1-800-MEDICARE or contact your local Senior Medicare Patrol for assistance: 1-877-808-2468 or www.SMPResource.org.

Suspect Medicare Fraud? Contact the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) fraud hotline:

Online: oig.hhs.gov/fraud/hotline
Phone: 1-800-447-8477 (1-800-HHS-TIPS)
TTY: 1-800-377-4950 | Fax: 1-800-223-8164

Facebook
Twitter
LinkedIn

Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24