A third-party claims reviewer for Blue Cross Blue Shield of Illinois discovered one of its physician peer reviewers was using someone else's identity, according to a sample letter posted on the Office of the Vermont Attorney General's website.
Dane Street, a vendor providing BCBSIL peer-to-peer reviews for denied claims, notified the insurer May 10 that law enforcement had accused the physician of fraudulently impersonating another physician to perform medical peer reviews. As a result, some members' personal health information may have been breached.
The letter, sent to some of BCBSIL's self-funded employer group health plan members, said individuals' names, addresses, phone numbers, dates of birth, Social Security numbers and medical service information may have been exposed in the incident.
BCBSIL did not disclose the number of individuals affected by the breach. As of Oct. 5, 2017, Dane Street no longer employed the provider, and implemented additional credentialing protocols to address fraud threats.
In an emailed statement to Becker's Hospital Review, BCBSIL said, "We take the security of our member's personal health information very seriously. We are aware that a person accused of fraudulently impersonating a licensed physician may have had access to the private information of a small number of our members. An investigation is underway and we are offering credit monitoring to those who may have been impacted."
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