Avoiding NPI Registry Scams: Tips for Protecting Your Identity and Information

Source: medscape.com

Did you know that, as per the NPI statistics, six physicians were on the verge of witnessing a financial disaster after a criminal tried to get their hands on their identities and also their NPI numbers? If you decode this story further, you will see that there was a con man in Florida that successfully stole the identities of six retired physicians who were semi-retired from their service. The conman was successfully running a Medicare fraud scam. The cam went on for 5 years, and the conman earned nearly $1.6 million.

If you see legal cases of a similar nature, you will not only feel scared but also feel that your personal information is at stake now and then. But, it should not push you to skip getting the NPI number. NPI Registry is important, and you should not miss it. Over the years, it has become popular because of its importance, and its implementation by the CMS has helped streamline the billing process. Also, it has resulted in adding more efficiency to it. All healthcare plans recognize it, so you should get one for yourself.

The Main Reason Behind NPI Security Issues

Source: forbes.com

Owing to their large-scale use, they have emerged as an integral part of the medical identities of healthcare providers. You can associate its use with that of a social security number. Now, when drawing points of similarities between the two, you should know that both are vulnerable to security issues that include data and identity theft.

The main reason behind this is that they are not confidential or protected to that extent. A person’s NPI is publicly available on the NPPES, which expands as the National Plan and Provider Enumeration System. Also, the NPI is in EHRs which enhances its accessibility by rogue employees and does not protect it from possible cyberattacks.

But do these factors mean you should rightfully sign up for a security breach of your important information?

Well, that should not be the case in any possibility.

Possibility Of The NPI Registry Scams

Source: advantumhealth.com

The case study you read earlier is not the only thing associated with NPI scams. If you dig more, you will discover thousands of NPIs stolen from healthcare professionals. The stolen information is then used to create fraudulent schemes every year. Particularly, these schemes revolve around conducting Medicare and Medicaid frauds.

There was a recent case of the United States Versus Michael, after which an appeal was filed with the U.S. Court of Appeals for the Sixth Circuit. It was held that the District Court has opted for a narrow interpretation of the term ‘fraud’.

The learning you can draw from this case is that if your NPI is stolen, millions of dollars in bogus prescriptions and unauthorized claims can be attributed front of you or the one whose NPI is stolen. The shocking fact is that this will happen before anyone learns about any related details. Now, if you become a part of such a happening, you must be a part of the investigation and present evidence that rules out your involvement in the held crime.

The CMS may cease your payments during the investigation. It will directly impact your finances, followed by social issues like hampering your reputation. All these things will impact your medical practice, too. Before any scenario comes into the picture, you should get an alert and do some settings.

When the crucial information from the NPI is stolen or misused by any healthcare provider, it not only gives rise to security breaches but also makes a person question the kind and quality of services they are signing up for.

Apart from the steps taken professionally, you should be careful and take some steps at your end to help you secure your information more.

Here are 3 tips from your stage to avoid NPI theft.

1. Getting The Awareness And Clarity

If you must share your NPI, you should be extra responsible and careful. You should know the reason for sharing it, its use, and its extended purpose. If you don’t ask for the details, your troubles will begin.

2. Proper Checking And Monitoring

Source: scientificworldinfo.com

Once you have completed your responsibility of taking down the necessary information related to NPI sharing, your job is not done. Instead, it started after you shared the number. It is because, post sharing, the risks are high. You should monitor the activities and check how it is being used by the people who have asked from you. For example, you can check the monitor claims and reimbursements that will help verify whether the billed services match your income. Whenever you see a mismatch, you should not ignore it. Instead, it indicates something is wrong, and your reimbursements are diverted to a bogus address.

Also, you can check your credit score and report if you cannot glance at this information. It is another reliable way of seeing any unusual behavior under your nose. If you cannot monitor these things for any reason, you should hire a trusted source to do these things on your behalf.

3. Reviewing The Situation And Timely Updates

When the NPI is stolen, getting your name cleared, followed by the relief of saving yourself from financial liability, is not an easy thing to do. However, if you have fallen prey to such an unfortunate incident, you can seek assistance from the CPI. If you suspect theft, you should contact the CPI. Also, if there are issues or potential threats, you can seek timely changes to prevent them from happening.


NPI security breach is an unfortunate situation. The worst part about it is that you have to take the legal test to prove your innocence and come out clean. Whenever you suspect any NPI-related malicious activity, you should contact the CPI and ensure that investigations are underway. Also, it would help if you did not forget to notify the officials about the data breach, followed by reevaluating data security and HIPAA compliance. When you follow these steps, you should do them carefully, as they will help prevent theft.