With reports about identity fraud making waves throughout the news media, it’s especially important for those looking at the American health care industry to consider a specific kind of identity fraud that can be especially expensive for victims. Medical fraud is commonly defined as any kind of identity theft that facilitates the use of insurance or medical information which allows for an unauthorized individual to get access to medical insurance, medical care or other services, or that in some cases, allows for false billing or funneling money directly from the victim to the fraud perpetrator. Learning more about it can help you avoid medical bankruptcies or other problems.

The Numbers on Medical Fraud

Although it may be more obscure than other types of fraud, for instance, credit card fraud, some reports estimate that medical identity theft affects almost two million people in America each year, with an overall monetary impact of over $40 billion. Experts also estimate the costs of medical fraud per victim at over $20,000. That means that this kind of fraud can destroy the budgets of many American consumers or families who become victims of this type of identity theft.

Common Scenarios

Experts suggest that some identity thieves pursue medical fraud in order to get insurance coverage through illegitimate means, while others may be looking to get their hands on prescription drugs that they will sell on the black market. But although these kinds of situations can hit consumers or families out of nowhere, other reports suggest that in many cases of medical fraud, there’s a gray area: the victims of these kinds of fraud may have let their family members misuse their medical information or otherwise been complicit in fraudulent claims or other types of identity theft.

Medical fraud is just one way that the average American family can find itself bogged down in medical debt or otherwise trapped in eternal debt cycles. In order to prevent these kinds of nightmare scenarios, it’s important to safeguard identity information and do regular credit checks and basic financial monitoring. You can also get help from third party medical advocates that understand the health care system and how to fight various kinds of financial challenges to make sure that you and your loved ones are not taken advantage of by a system that often generates extremely high costs. Talking to these types of agencies and organizations can help you gain a better idea of how to prevent medical fraud, unfair denials or bills, or any other financial struggle that could have been avoided through good documentation and vigilance. Get the facts and protect yourself against medical fraud and unfair medical debt for a better financial future.

At the Peace in Medicine Healing Center in Sebastopol, the wares on display include dried marijuana – featuring brands like Kryptonite, Voodoo Daddy and Train Wreck – and medicinal cookies arrayed below a sign saying, “Keep Out of Reach of Your Mother.”

Several Bay Area doctors who recommend medical marijuana for their patients said in recent interviews that their client base had expanded to include teenagers with psychiatric conditions including attention deficit hyperactivity disorder.

“It’s not everybody’s medicine, but for some, it can make a profound difference,” said Valerie Corral, a founder of the Wo/Men’s Alliance for Medical Marijuana, a patients’ collective in Santa Cruz that has two dozen minors as registered clients.

Because California does not require doctors to report cases involving medical marijuana, no reliable data exist for how many minors have been authorized to receive it. But Dr. Jean Talleyrand, who founded MediCann, a network in Oakland of 20 clinics who authorize patients to use the drug, said his staff members had treated as many as 50 patients ages 14 to 18 who had A.D.H.D. Bay Area doctors have been at the forefront of the fierce debate about medical marijuana, winning tolerance for people with grave illnesses like terminal cancer and AIDS. Yet as these doctors use their discretion more liberally, such support – even here – may be harder to muster, especially when it comes to using marijuana to treat adolescents with A.D.H.D.

“How many ways can one say ‘one of the worst ideas of all time?’ ” asked Stephen Hinshaw, the chairman of the psychology department at the University of California, Berkeley. He cited studies showing that tetrahydrocannabinol, or THC, the active ingredient in cannabis, disrupts attention, memory and concentration – functions already compromised in people with the attention-deficit disorder.

Advocates are just as adamant, though they are in a distinct minority. “It’s safer than aspirin,” Dr. Talleyrand said. He and other marijuana advocates maintain that it is also safer than methylphenidate (Ritalin), the stimulant prescription drug most often used to treat A.D.H.D. That drug has documented potential side effects including insomnia, depression, facial tics and stunted growth.

In 1996, voters approved a ballot proposition making California the first state to legalize medical marijuana. Twelve other states have followed suit – allowing cannabis for several specified, serious conditions including cancer and AIDS – but only California adds the grab-bag phrase “for any other illness for which marijuana provides relief.”

This has left those doctors willing to “recommend” cannabis – in the Alice-in-Wonderland world of medical marijuana, they cannot legally prescribe it – with leeway that some use to a daring degree. “You can get it for a backache,” said Keith Stroup, the founder of the National Organization for the Reform of Marijuana Laws.

Nonetheless, expanding its use among young people is controversial even among doctors who authorize medical marijuana.

Gene Schoenfeld, a doctor in Sausalito, said, “I wouldn’t do it for anyone under 21, unless they have a life-threatening problem such as cancer or AIDS.”

Dr. Schoenfeld added, “It’s detrimental to adolescents who chronically use it, and if it’s being used medically, that implies chronic use.”

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said she was particularly worried about the risk of dependency – a risk she said was already high among adolescents and people with attention-deficit disorder.

Counterintuitive as it may seem, however, patients and doctors have been reporting that marijuana helps alleviate some of the symptoms, particularly the anxiety and anger that so often accompany A.D.H.D. The disorder has been diagnosed in more than 4.5 million children in the United States, according to the Centers for Disease Control and Prevention.

Researchers have linked the use of marijuana by adolescents to increased risk of psychosis and schizophrenia for people genetically predisposed to those illnesses. However, one 2008 report in the journal Schizophrenia Research suggested that the incidence of mental health problems among adolescents with the disorder who used marijuana was lower than that of nonusers.

Marijuana is “a godsend” for some people with A.D.H.D., said Dr. Edward M. Hallowell, a psychiatrist who has written several books on the disorder. However, Dr. Hallowell said he discourages his patients from using it, both because it is – mostly – illegal, and because his observations show that “it can lead to a syndrome in which all the person wants to do all day is get stoned, and they do nothing else.”

Until the age of 18, patients requesting medical marijuana must be accompanied to the doctor’s appointment and to the dispensaries by a parent or authorized caregiver. Some doctors interviewed said they suspected that in at least some cases, parents were accompanying their children primarily with the hope that medical authorization would allow the adolescents to avoid buying drugs on the street.

A recent University of Michigan study found that more than 40 percent of high school students had tried marijuana.

“I don’t have a problem with that, as long as we can have our medical conversation,” Dr. Talleyrand said, adding that patients must have medical records to be seen by his doctors.

The Medical Board of California began investigating Dr. Talleyrand in the spring, said a board spokeswoman, Candis Cohen, after a KGO-TV report detailed questionable practices at MediCann clinics, which, the report said, had grossed at least $10 million in five years.

Dr. Talleyrand and his staff members are not alone in being willing to recommend marijuana for minors. In Berkeley, Dr. Frank Lucido said he was questioned by the medical board but ultimately not disciplined after he authorized marijuana for a 16-year-old boy with A.D.H.D. who had tried Ritalin unsuccessfully and was racking up a record of minor arrests.

Within a year of the new treatment, he said, the boy was getting better grades and was even elected president of his special-education class. “He was telling his mother: ‘My brain works. I can think,’ ” Dr. Lucido said.

“With any medication, you weigh the benefits against the risks,” he added.

Even so, MediCann patients who receive the authorization must sign a form listing possible downsides of marijuana use, including “mental slowness,” memory problems, nervousness, confusion, “increased talkativeness,” rapid heartbeat, difficulty in completing complex tasks and hunger. “Some patients can become dependent on marijuana,” the form also warns.

The White House’s recent signals of more federal tolerance for state medical marijuana laws – which pointedly excluded sales to minors – reignited the debate over medical marijuana.

Some advocates, like Dr. Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard University, suggest that medical marijuana’s stigma has less to do with questions of clinical efficacy and more to do with its association, in popular culture, with illicit pleasure and addiction.

Others, like Alberto Torrico of Fremont, the majority leader of the California Assembly, argue for more oversight in general. “The marijuana is a lot more powerful these days than when we were growing up, and too much is being dispensed for nonmedical reasons,” he said in an interview last week, bluntly adding, “Any children being given medical marijuana is unacceptable.”

As advocates of increased acceptance try to win support, they may find their serious arguments compromised by the dispensaries’ playful atmosphere.

OrganiCann, a dispensary in Santa Rosa, has a Web site advertisement listing the “medible of the week” – butterscotch rock candy – invitingly photographed in a gift box with a ribbon. OrganiCann also offers a 10 percent discount, every Friday, for customers with a valid student ID.

1. Keep a current and comprehensive list of all of the medications you are taking. Include not only those obtained by prescription, but also over-the-counter medications such as cold remedies, aspirin, vitamins and herbal supplements. On this list, also include any allergies you have to medications, and any other allergies you have.
2. Whether you use one or multiple pharmacists, be sure that all have a copy of your medications list (see #1).
3. When you go to any doctor, give the doctor a copy of your medications list (see #1).
4. When a doctor gives you a written prescription, ask him the name of the medication, its purpose, and dosage. Have him point to the information on the prescription paper. In haste, sometimes a doctor may forget to write the “milligrams” or “frequency,” etc. By having him “read” the prescription to you, he will catch any information accidentally skipped.
5. If you can’t read the doctor’s handwriting on the prescription, there is high likelihood that the pharmacist won’t be able to either. Is the number a “7” or a “2”? Is your name spelled clearly and correctly? Politely ask the doctor to rewrite the prescription to ensure the pharmacist can follow the instructions. If the doctor is insulted, just tell him you’re trying to save him or his staff the time of returning a pharmacist’s phone call later on to clarify the prescription. This request is also crucial because often a doctor’s nurse will handle pharmacy calls, and she may misread the doctor’s illegible handwriting which could result in your getting the wrong medicine.
6. Ask your doctor “What are the common side effects of this medication?” This will make you aware of potential complications.
7. Ask your doctor: “What should I do if I experience any of the side effects you named or others?” This will give you a clear action plan, rather than waiting out what could be precious time to see if the side effects dissipate or the potential panic of trying to obtain medical care quickly.
8. Ask your doctor: “Do I need to take this medication with or without food?” A drug-food interaction can occur if directions are not properly followed; the food you do or do not eat can affect the ingredients in a medicine you are taking so the medicine cannot work the way it should. For example, taking some medicines at the same time that you eat may interfere with the way your stomach and intestines absorb it. The food may delay or decrease the absorption of the drug. On the other hand, some medicines are easier to tolerate when taken with food.
9. Ask your doctor: “Will or can this drug interfere with any of the other medications I take?” (Be certain he has your most recent medications list.) Your doctor may need to make adjustments to prevent potential problems. For supplemental information, there are a variety of internet sites in which you can research drug interactions.
10. Keep a photocopy of the prescription for yourself. You can ask the doctor’s front office staff to make a copy for you when you check-out.
11. When you pick up your medicine at the drugstore (or receive it in the mail), refer to your photocopy of the prescription to make sure it is what the doctor ordered.
12. If you use a drugstore, when you pick up the medicine and the pharmacist inquires if you have any questions, ask the pharmacist to go over the medicine and dosage requirements. Even though your doctor already provided this explanation, hearing the information a second time will only help ensure you take the medication safely and accurately.
13. Don’t mix medicine into hot drinks because the heat may keep the drug from working. And, never take medicine with alcoholic drinks.
14. Don’t stop taking your medication just because you “feel better.” Complete the entire required dosage (unless instructed otherwise by your physician). If you arbitrarily quit, there is high probability your symptoms or illness will return.