Rebecca Nicole Hannah Zajac is not a name two people are likely to have. Yet, my daughter, living in the United States, found that someone with this name and the same birthday as her had opened three bank accounts and overdrawn these accounts substantially. Thus, when Rebecca came to open a bank account in New York City, she was told it was not possible because she already had three accounts on which money was owed at another bank. This is a real and not uncommon scenario in the US where, because of the complexity of the banking system, identity fraud is rife. For Australians visiting or living in the US since the new homeland security laws came into force, it is quite difficult to open a bank account there. On the other hand, having one’s credit card skimmed to duplicate the cardholder’s name, the card’s number and other data is easy.

What might surprise you is that medical identity fraud is now becoming a significant issue in the US. An article in the New York Times in July 2009 described a person who discovered, on checking his credit rating, that he owed tens of thousands of dollars for medical bills.1 This included visits to emergency rooms and an air-ambulance flight. According to a 2006 World Privacy Forum report, more than 250 000 Americans were affected by medical identity theft in 2005.2

For us, it is quite difficult to conceive how this process works. An Australian who goes to a public hospital emergency room incurs no cost. In the US, a visit to the emergency room, whether public or private, incurs substantial fees. For uninsured patients, these fees are often payable in advance, unless the patient has a life-threatening illness, in which case the money will be collected later. Using another person’s identity, including his or her name and Social Security number shifts the bill to that unfortunate person.

A slight variation on this theme involves patients going to the doctor and using someone else’s name and insurance identification number to get free treatment, including, apparently (according to the New York Times article), major elective surgery.

As some forms of US health insurance have a lifetime cap on financial benefits, someone else using your insurance could, in fact, use it all up.

Medicare fraud in Australia, which was reported to occur in the early days of Medicare, involved doctors billing patients whom they had not seen, or billing patients for additional and longer visits. If President Obama’s public insurance scheme is passed, it is possible that a similar problem could occur in the US.

President Obama stated that a significant goal of his new health policy would be the generation of transportable, up-to-date, reliable electronic medical records. This is a worthwhile goal, and if it comes to pass and develops technology that can be used in Australia, it will have a substantial and positive effect on our health care system. However, in the US, if someone were to get hold of your electronic record and use it as part of a medical insurance identity fraud, their medical information could become entangled with yours. Obviously, for patients with relatively short medical records, regular review would pick this up immediately. However, for many older patients with very complicated medical histories, this may not be readily apparent, and could potentially cause a major health problem. It could lead to incorrect blood transfusion, incorrect drug prescription or incorrect surgery.

The possibility of incorrect data within an electronic medical record is a major issue. Anyone used to dealing with large computer files will recognise the problem at once. Misfiling in paper hospital records occurs, but it is usually obvious when a result or history relates to a patient other than the owner of the file. In an electronic record, if the content is divorced from the name, or if fraud is involved, medical staff seeing the patient for the first time might not detect the error. As in many things, future developments in Australia are seen first in the US. It is to our advantage that foresight is a wonderful gift.

However, we must remain mindful that, like many clever ideas originating in the US, this one may have a substantial downside if we are not very careful.