Invention Grant
US08688607B2 System and method for detecting healthcare insurance fraud 有权
检测医疗保险欺诈的制度和方法

  • Patent Title: System and method for detecting healthcare insurance fraud
  • Patent Title (中): 检测医疗保险欺诈的制度和方法
  • Application No.: US13162560
    Application Date: 2011-06-16
  • Publication No.: US08688607B2
    Publication Date: 2014-04-01
  • Inventor: Debra Pacha
  • Applicant: Debra Pacha
  • Agency: McKinney Law, PLLC
  • Main IPC: G06F17/00
  • IPC: G06F17/00 G06N5/00
System and method for detecting healthcare insurance fraud
Abstract:
A system and method for detecting healthcare insurance fraud is disclosed. The method includes creating a database containing source data related to at least one healthcare claim submitted for reimbursement, selecting data from the database to compare to a set of rules using an audit module, and comparing the selected data to the set of rules using the audit module. The method also includes using the audit module to automatically identify suspected fraudulent data when the selected data violates at least one rule of the set of rules and using the audit module to flag the fraudulent data. In addition, the method includes using the audit module to generate a report illustrating patterns of irregularities within the source data to visually identify the fraudulent data displayed within the source data by user-friendly graphs and charts, and generating at least one automated statement for display to identify the at least one rule of the set of rules that was violated by the selected data using a documentation module.
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