Who are you? Misadventures in misidentification

Being misidentified – or having your identity stolen – can bite hard. But when it comes to your medical ID, the consequences might be especially serious. Not only can it create havoc with figuring out who’s supposed to pay the bill, but it also could lead to unintentional errors in the patient’s care.

I learned this the hard way several years ago when I was hospitalized in the Twin Cities. It happened to be the same hospital where my sister-in-law gave birth to her two children. She and I have the same first name and same last name, with different middle initials. Our dates of birth are the same month and same year, just four days apart.

You guessed it – I was mistaken for her. By sheer chance, the person at the admitting desk mentioned casually, “Oh, I see you’ve been a patient here before.” I had not, and I quickly realized she was talking about my sister-in-law. We managed to straighten it out, but not before the wrong medical chart was sent up to the patient floor.

I thought that would be the end of it. I was wrong. Not long after the bills went out, my sister-in-law called me. The information that we were two separate persons apparently never reached the physician clinic, and as a result they billed her instead of me for the doctor’s services. Meanwhile the hospital bill was languishing in some kind of limbo. I waited for the insurance statement… and waited… and waited. After two months went by, I called my insurer to ask what was taking so long. The reply: They couldn’t process the bill because they didn’t have the medical record. I called the hospital and was told they couldn’t send the medical record to my insurer because I hadn’t signed the release form. It was news to me; I clearly remembered signing a whole stack of forms. Somehow, in the scramble after the identity mix-up, they must have been misfiled or disappeared.

All told, it took several long-distance phone calls and a letter to get this relatively minor confusion straightened out. The admissions paperwork I’d signed never resurfaced. And to this day, I can’t be totally sure that my medical record and that of my sister-in-law haven’t been at least partially co-mingled.

That’s why I sat up and took notice when Rice Memorial Hospital adopted a policy earlier this month on addressing and preventing patient misidentification. Other hospitals are taking similar action; in fact, new rules by the Federal Trade Commission require them to do so. They have until Aug. 1 to comply.

Patient misidentification tends to fall into three broad categories: inadvertently confusing one patient for another; using a false ID; and outright medical identity theft.

Of the three, medical identity theft is, hands down, the most challenging to address. Here’s what the World Privacy Forum has to say:

Medical identity theft occurs when someone uses a person’s name and sometimes other parts of their identity – such as insurance information – without the person’s knowledge or consent to obtain medical services or goods, or uses the person’s identity information to make false claims for medical services or goods. Medical identity theft frequently results in erroneous entries being put into existing medical records, and can involve the creation of fictitious medical records in the victim’s name.

Medical identity theft is a crime that can cause great harm to its victims. Yet despite the profound risk it carries, it is the least studied and most poorly documented of the cluster of identity theft crimes. It is also the most difficult to fix after the fact, because victims have limited rights and recourses. Medical identity theft typically leaves a trail of falsified information in medical records that can plague victims’ medical and financial lives for years.

How common is medical identity theft? One estimate puts it at about 3 percent of the 8 million or so cases of identity theft that occur in the United States each year. Many experts worry that with the increasing use of online medical records, the incidence of medical identity theft will rise.

Many victims might not even know their medical identity has been stolen until they receive an unexpected bill or discover it on their credit report, as this recent New York Times article recounts.

Locally, these situations don’t appear to be too common – at least yet. More often, what local providers encounter is someone using a false ID that has been obtained for employment. It can sow doubt and confusion over the patient’s real identity and increase the risk of an inaccurate or incomplete medical record. It also makes it harder to determine whom to bill.

And any patient, of course, can fall victim to simple error. It may be tiresome for patients to have to repeat their name over and over during a hospital stay, but it helps ensure the wrong procedure or the wrong medication doesn’t accidentally reach the patient. Most hospitals now use at least two identifiers – name and date of birth – to make sure the patient is correctly identified. They also typically have procedures they follow when two patients with the same name happen to be hospitalized at the same time. Some hospitals also have adopted bar coding to further reduce the risk of patient misidentification.

As this case study from the Agency for Healthcare Research and Quality shows, however, mistakes can still happen. In the worst-case scenario, someone might undergo surgery intended for someone else, or parents might unwittingly take home the wrong infant.

The best defense, say experts, is to be vigilant. Get copies of your medical records, scrutinize the bill, and speak up if something doesn’t seem right. The fact is, if it hadn’t been for an off-the-cuff remark by a hospital admissions clerk, I would never have known about my medical identity mix-up until much later. And the longer you wait, the harder it can be to correct the problem.

HealthBeat photo by Anne Polta

2 thoughts on “Who are you? Misadventures in misidentification

  1. As part of the admissions procedure, one must present your insurance identification card reflecting identifying patient information. Copies are made of the caard to be made part of the medical record to show proof of insurance for the admission with the original card returned to the patient being admitted. I noticed this has been left out of the story so can only presume the patient did not produce nor was asked for the card which probably caused the mistaken identiy.

  2. I’m pretty sure they asked for my insurance card because the hospital did bill the correct insurer. The issue was with the physician group, which billed separately for the physician services.

    This incident happened quite a few years ago when perhaps there wasn’t as much attention focused on patient misidentification. I thought it was interesting, and a little alarming, that the wrong chart had already been sent up to the patient floor before I was admitted. My guess is they just assumed my sister-in-law and I were the same person, and the admissions procedure wasn’t set up to catch this kind of error.

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