Invention Grant
- Patent Title: Machine-learning concepts for detecting and visualizing healthcare fraud risk
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Application No.: US16028668Application Date: 2018-07-06
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Publication No.: US10692153B2Publication Date: 2020-06-23
- Inventor: Elizabeth Mae Obee , Sheila Greene , Marcus Alan Ballard , Jacques Bellec
- Applicant: Optum Services (Ireland) Limited
- Applicant Address: IE Dublin
- Assignee: Optum Services (Ireland) Limited
- Current Assignee: Optum Services (Ireland) Limited
- Current Assignee Address: IE Dublin
- Agency: Alston & Bird LLP
- Main IPC: G06Q40/08
- IPC: G06Q40/08 ; G06N20/20 ; G06F3/0483 ; G06N20/00

Abstract:
Machine-learning concepts for detecting and visualizing healthcare fraud, waste, and abuse risk using a data driven decision and investigations support system. The concepts comprise an analytic core that processes a large amount of data, generates an overall risk score, and ranks healthcare providers and/or members. The overall risk score is an integrated score encompassing multiple categories of risk. The multiple categories of risk factors include multiple definitions of what defines risk, allowing for a synergistic effect between the risk analytics, where the overall effect of the combination is greater than the sum of the effects of any one definition of risky behavior by a provider or member. Utilizing this approach a unique risk profile of healthcare providers and members is generated and visualized to the user. Various embodiments further encompass a user interface that comprises linked panels that display targeted information regarding providers and members.
Public/Granted literature
- US20200013124A1 MACHINE-LEARNING CONCEPTS FOR DETECTING AND VISUALIZING HEALTHCARE FRAUD RISK Public/Granted day:2020-01-09
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