How to Correct Medical Records and Stop Medical Identity Theft in Wisconsin

The Hidden Danger of Medical Identity Theft

When most people think of identity theft, they worry about stolen credit cards or drained bank accounts. However, medical identity theft-where an imposter uses your name and insurance information to get surgeries, prescription drugs, or treatment-is arguably far more dangerous. If an imposter receives medical care in Milwaukee, Madison, or La Crosse under your identity, their medical history becomes mixed with yours. This means a hospital portal might suddenly list a severe drug allergy you do not have, or an incorrect blood type, which could lead to fatal medical errors in an emergency.

Correcting these records is not as simple as making a phone call; it requires leveraging your rights under the federal HIPAA Privacy Rule and strict state statutes like Wis. Stat. § 146.82 (Health care records). If a hospital refuses to correct your file, consulting a specialized healthcare or consumer protection attorney from our directory is essential to force compliance and protect your life and insurance standing.

Step-by-Step Process to Correct Medical Records

To safely untangle your medical history from an imposter's, you must formally invoke your legal rights. Follow these steps meticulously to ensure healthcare providers take your claims seriously.

Step 1: Removing False Diagnoses or Blood Types

If you discover false information in your MyChart or patient portal, do not simply ask a nurse to delete it. Under 45 C.F.R. § 164.526, you have the formal right to request an amendment to your medical record. You must submit a written request to the hospital's Privacy Officer or Health Information Management (HIM) department. Clearly state what information is incorrect (e.g., a fake diabetes diagnosis or wrong blood type) and provide a reason (identity theft). If the hospital refuses, they must provide a written denial, and you have the right to submit a formal 'Statement of Disagreement' that must be permanently attached to your medical file.

Step 2: Appealing Denied Health Insurance Claims

An imposter's medical treatments will often exhaust your health insurance limits. For instance, if an imposter uses your benefits for costly back surgery, your insurance may later deny your own legitimate claims, stating you have reached your annual limit. You must immediately contact your health insurer's fraud department. Provide them with a police report and a sworn affidavit of medical identity theft. You will likely need to go through a formal internal appeal process. If the insurer still refuses to cover your legitimate treatments, your lawyer can file a complaint with the Wisconsin Office of the Commissioner of Insurance, Madison.

Step 3: Dealing with Medicare and Medicaid Fraud

Elderly patients are frequently targeted for Medicare or Medicaid fraud. If you notice strange charges on your Medicare Summary Notice (MSN) for wheelchairs you never received or clinics in Green Bay you never visited, report it immediately to the Office of Inspector General (OIG). For state-level Medicaid (BadgerCare) fraud, report the issue to the Wisconsin Department of Health Services, Madison. State and federal agencies take public health fraud very seriously, and an attorney can help you secure your benefits while the investigation is pending.

Step 4: Suing Healthcare Providers for Negligence

If a clinic or hospital negligently allowed someone to use your identity without checking for a basic ID, and it resulted in severe financial harm or a medical crisis for you, you may have grounds for a lawsuit. Under principles established in cases related to medical confidentiality and negligence, such as Hannigan v. Sundby Pharmacy, Inc., 224 Wis. 2d 910 (WI Court of Appeals 1999), healthcare providers have a duty of care. If they failed to verify the patient's identity and subsequently refused to correct your corrupted medical records, your attorney can file a civil lawsuit in a local court, such as the Milwaukee County Circuit Court, Milwaukee.

How Much Does it Cost in Wisconsin?

Requesting an amendment to your medical records under HIPAA is generally free, though hospitals are allowed to charge a reasonable, cost-based fee for making copies of your records under Wis. Stat. § 146.83 (typically a few dollars). If you need to hire an attorney to force a hospital to comply, legal fees can vary. Many attorneys charge hourly rates between $250 and $500 for administrative health law matters. However, if the medical identity theft resulted in a severe injury to you (medical malpractice due to corrupted records), personal injury attorneys will take the case on a contingency fee basis.

How Long Does the Process Take?

Under the HIPAA Privacy Rule, a healthcare provider must act on your request to amend your medical records within 60 days of receiving it. They are allowed one 30-day extension if they provide you with a written reason for the delay. If the hospital refuses your request and you must file a formal federal complaint using Form HHS-700, FED, HHS OCR, Health Information Privacy Complaint with the U.S. Department of Health and Human Services, Chicago, the federal investigation can take anywhere from 6 months to over a year.