What to Do If Your Medical Identity is Stolen in Hawaii: Correcting Your Health Records

The Dangers of Medical Identity Theft in Hawaii

Medical identity theft occurs when someone fraudulently uses your name, Social Security Number, or health insurance subscriber ID to obtain medical services, prescription drugs, or devices. In Hawaii, where many residents rely on major providers like HMSA, Kaiser Permanente, or the state's Medicaid program (QUEST Integration), an imposter's actions can devastate your financial and physical well-being. Unlike a stolen credit card, medical identity theft blends the imposter's medical history with your own. This means that an emergency room doctor in Honolulu or Hilo might make life-or-death decisions based on a chart that incorrectly lists the imposter's blood type, allergies, or underlying diseases.

Removing Fraudulent Diagnoses from Medical Charts

If you suspect someone has used your identity to receive healthcare, your first step is to correct your clinical records. Under federal law, specifically the 45 C.F.R. § 164.526, you have the right to request an amendment to your medical records. You should contact every hospital, clinic, and pharmacy where the imposter received treatment and submit a formal written request to their medical records department. You must clearly identify the fraudulent entries, such as a diagnosis you have never had or a surgery you never underwent, and request their immediate removal. The facility must generally respond to your request within 60 days, though complex cases may take longer. If the provider refuses to amend the chart, they must allow you to insert a statement of disagreement into your permanent file.

Appealing Denied Legitimate Claims Due to Maxed-Out Benefits

Health insurance plans, including Hawaii QUEST Integration and private HMSA policies, have annual or lifetime limits on certain treatments, such as physical therapy sessions, dental work, or specialized medical equipment. If an imposter exhausts your benefits, your legitimate claims will be denied. When this happens, you must file a formal appeal with your insurance provider. You will need to submit a police report and an affidavit of identity theft to prove that the prior claims were fraudulent. By demonstrating that the services were not rendered to you, your insurance company can reverse the claims, restore your benefit limits, and cover your necessary medical treatments.

HIPAA Rights Regarding Accounting of Disclosures

To fully understand the extent of the theft, you must find out exactly where your medical information was sent. Under 45 C.F.R. § 164.528, you have the right to request an 'Accounting of Disclosures' from your healthcare providers and your insurance company. This document will list every entity that received your medical information over the past six years. This step is critical for tracking down secondary facilities, such as outside laboratories or physical therapy clinics, that may also have fraudulent records in your name. If your provider fails to comply, you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, San Francisco using Form OCR-0945-0002, FED, U.S. Department of Health and Human Services, Health Information Privacy Complaint.

Reporting the Crime and Protecting Your Future

Because medical identity theft frequently involves state and federal programs, it is considered a serious crime. If the imposter used your Hawaii Medicaid (QUEST) benefits, you must immediately report the fraud to the Hawaii Department of Human Services, Med-QUEST Division, Kapolei. Furthermore, under Hawaii state law, identity theft is aggressively prosecuted. You should file a police report with your local county police department, making sure to explicitly mention medical identity theft. Finally, review all Explanation of Benefits (EOB) statements the moment they arrive in the mail. If you see a doctor's name you do not recognize, contact your insurer immediately.

Frequently Asked Questions (FAQ)