Bogleheads

[nisiprius]

In order to remove any possible ambiguity: this is just idle curiosity on my part. The idea of impersonating someone else in order to "steal" their surgery might be an entertaining idea for a fictional story, but it would be crazy even to think of trying it.

[livesoft]

I had the same experience this week with surgery. I showed up in my gym shorts, T-shirt and sandals. I did not need any ID nor credit card. I did need a ride home though.

I'm pretty sure I wouldn't go for free surgery. It's not pleasant in the first place and the follow-ups would be kinda tricky, wouldn't they?

[czeckers]

It could be theoretically possible, but risky.

Places are supposed to check ID and insurance cards. Many even photo copy them. So you'd have to know in advance of a surgicenter that is sloppy about this.

There are surgeons who have an NP or PA see the patients in the office and meet the patient for the first time day of surgery so facial recognition may actually not be a problem.

Next, you'd have to know exactly what surgery you need, as well as someone else having the same procedure done on the correct side. This may be easier with routine generic procedures such as a carpal tunnel or a D&C, but wouldn't work for shoulder surgery because you may not know what specific repair is planned: acromioplasty, rotator cuff repair, SLAP repair, etc. Any procedure that is planned on the basis of x-rays or MRIs could betray you if your pathology doesn't match the imaging data.

You'd also have to know the date and time. Many times the patient doesn't know the time until the day before. Without access to the surgicenter's schedule, you'd have to rely on coincidence that you just happen to know someone who is planning to have the exact thing done that you need, and you know them well enough for them to have contact with you on the day before the surgery and have them tell you the expected time.

Finally, you'd have to be fairly young and healthy and the same gender, and similar physical size. Most of the time, surgicenters already have your health information on file before you show up, as well as a copy of your most recent ECG. When they go over your health history, they are basically confirming what they already know about you. Any significant changes in weight, height, reported health history, medications, allergies, ECG could betray you.

Is it possible? Of course. Likely? Not really.

I think the much bigger risk is someone impersonating you from the beginning. They get your insurance information and use a fake ID to be you. Then they check into an out of town hospital to treat whatever ails them. By the time you get your insurance statement, they can be long gone. Since it is out of town, they probably won't have your PCP's info so they could just say they don't have a doctor and there won't be a search for old medical records. Unless the admission leaves some permanent evidence such as a surgical scar, you'd have a very hard time proving that it wasn't you.

-K
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"A journey of a thousand miles must begin with a single step."

[mfen]

Years ago I had someone steal my identity for surgery. Employees at the hospital went through the plans to find inactive accounts. I don't know how they were going to bill this surgery but my mother got a phone call the day before the scheduled surgery to remind me of the necessary safeguards. I had long since left town.

What horrified me was when I immediately called back to investigate the issue and let them know it was all fraudulent I was told there was nothing I could do about canceling the procedure. This was a hospital that has its own health plan which I had coverage with as a minor. So down the road I will have to deal with someone having gotten a mastectomy on my profile. Outrageous. If I had been a little wiser I guess I should have flown back to my hometown to confront the surgeon the next morning. That was my only option.
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Maryanne

[dm200]

Yes, it happens.

A few years ago, the benefits director of the local Catholic Diocese and her sister (not a participant in the health plan) went out west (we are on the east coast) and each had cosmetic surgery (tummy tucks, etc.). The Diocese health insurance paid for all the surgery. These "benefits" were not legitimate for coverage under health insurance. The employee (benefits director) pushed it through because she was in charge of the program. Her sister assumed the identity of a cloistered nun, who was in the plan.

Some kind of an audit later discovered the fraud.

[norookie]

Wow.....come to think of it me too, Nisiprius. I had pre-testing a week before/Blood test/etc. However no other Identification was required registering my personal stats except the dr.s recognition of me wheeled in to the operating room before the procedure. I do not think a Dr would operate on the wrong patient with the liabilities they face these days. JMO
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"I hope to put my last dime when I die, in the parking meter in front of the state house, then die in my car awaiting many parking tickets"

[vandering]

The first scenario won't fly unless it's a real Bourne Identity kind of thing because the protocol is that Anesthesiologist or CRNA doesn't put my patient to sleep GETA until I wish him or her sweet dreams. If you're operating without having met/worked up the patient in advance, then you should reconsider that Career in Pathology.
The last scenario apparently does fly. Layperson X uses Religious orders Y's insurance/demographics.
This would actually be obviated by an electronic medical record and a physician who's not asleep at the wheel. You can't physically fake that many data points. pe.vs.labs.xray.
The scenario of someone having a mastectomy on your tab I can't even begin to wrap my head around ?

[nisiprius]

[bottlecap]

nisiprius:

Very interesting. I'll one-up you. Let's say someone you know needs surgery and you have insurance and they don't. In exchange for a "fee" that is less than the price of the surgery (saving them money), you give them your insurance cards and information (or perhaps phone in some of the information - my wife just did that for me), and they show up to the initial and all following appointments as you. Viola.

As far as a photo id, I'm sure your co-conspirator could get a decent enough one to fool a receptionist.

I bet this has happened before, as while not foolproof, it seems workable.

[dave.d]

This would be extremely dangerous, wouldn't it? What if they rely on your medical records about allergies, or give you the wrong blood type? You could be dead.

[pshonore]

[mfen]

[nisiprius]

[wshang]

Yeah, the imposter's come uppance will arrive when they start the transfusion during surgery. Imagine the chagrin when they suffer a massive transfusion reaction.

Presuming they survive, I wonder whether insurance will cover the ensuing kidney transplant?