System and method for implementing healthcare fraud countermeasures

• US 20040143454A1
• Filed: 01/22/2003
• Published: 07/22/2004
• Est. Priority Date: 01/22/2003
• Status: Active Grant

• Current Assignee: Biometric Technologies Incorporated
• Original Assignee: Biometric Technologies Incorporated
• Inventors: Kimmel, Scott T.
• Granted Patent: US 7,209,886 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A method of discouraging healthcare fraud in conjunction with providing a health care service to a patient in which the patient provides a biometric signature. An event record is created where the event record creates an association between the biometric signature, a patient identifier, and location information indicating a location at which the biometric signature is obtained. The event record is stored in a central data store and can be later retrieved to verify the patient was present at the location.

Claims

1. A method of discouraging healthcare fraud comprising:

in conjunction with providing a health care service to a patient, causing the patient to provide a biometric signature;

creating an event record comprising an association between the biometric signature, a patient identifier, and a location information indicating a location at which the biometric signature is obtained;

storing the event record in a central data store.

2. The method of claim 1 wherein the act of storing is performed before the biometric reading is used to identify the person receiving the healthcare services.

3. The method of claim 1 wherein the act of storing is performed before the biometric reading is used to authenticate the person receiving the healthcare service.

4. The method of claim 1 wherein the healthcare service comprises a service that is reimbursable by a private insurance plan and/or a public program.

5. The method of claim 1 further comprising obtaining a biometric signature at least two times during the provision of health care services.

6. The method of claim 1 further comprising:

receiving a claim for reimbursement for the health care services;

retrieving one or more event records corresponding to the health care services from the central data store;

determining whether the one or more event records indicate that the patient was at a suitable location for providing the health care services; and

authorizing financial reimbursement of the health care service based in part upon the determination that the patient was present at a location suitable for providing the health care service.

7. The method of claim 1 further comprising:

retrieving one or more records from the central data store; and

performing a fraud detection process using the retrieved records.

8. The method of claim 1 wherein the biometric signature comprises a fingerprint scan record.

9. The method of claim 1 further comprising:

including within the event record an indication of consumable materials used during provision of the healthcare services.

10. The method of claim 1 further comprising:

including within the event record and indication of equipment used during provision of the healthcare services;

.

11. The method of claim 1 further comprising:

including within the event record an indication of procedures performed during the provision of the healthcare services.

12. The method of claim 1 wherein the location information comprises an identification code assigned to a heath care facility.

13. The method of claim 1 wherein the location information comprises a geocode.

14. The method of claim 1 wherein the location information comprises a network address of a computer used to obtain the biometric signature.

15. The method of claim 1 wherein the location in formation comprises a device address of a fingerprint scanner.

16. A biometric audit trail system comprising:

means for obtaining biometric information from a person at a particular location, the particular location being associated with a location identification;

a biometric record comprising the biometric information and the location identification;

a central storage system for storing the biometric record with a plurality of other biometric records; and

processes for retrieving biometric records at a later time from the central storage system to audit locations visited by particular persons.

17. The system of claim 16 further comprising processes operable to analyze the retrieved biometric records to identify patterns amongst a plurality of biometric records.

18. The system of claim 16 wherein the biometric record further comprises a timestamp indicating a time at which the biometric information was obtained.

19. A method of preventing fraud comprising:

providing a biometric registration system at a physical location at which goods and/or services are provided to a person;

upon providing of the goods and/or services, obtaining a biometric reading from a person receiving the goods and/or services; and

storing the biometric reading together with indicia of the physical location.

20. The method of claim 19 wherein the act of storing is performed before the biometric reading is used to identify the person receiving the goods and/or services.

21. The method of claim 19 wherein the act of storing is performed before the biometric reading is used to authenticate the person receiving the goods and/or services.

22. The method of claim 19 wherein the goods and/or services comprise medical treatment.

23. The method of claim 19 further comprising obtaining a biometric reading at least two times during the provision of goods and/or services.

24. An event record comprising:

at least one biometric signature uniquely associated with a participant in an event;

location information indicating one or more locations at which the event occurred; and

at least one timestamp indicating a time at which the event occurred.

25. Claims management software for comprising:

an interface for receiving claim input reflecting information about a claim for reimbursement, wherein the claim input is related to health care services provided to an insured person;

processes for evaluating the claim input to determine whether payment of the claim is justified; and

an interface operable to receive information related to the claim input indicating whether the insured person in fact received the health care services for which the claim for reimbursement relates.

26. Practice management software including processes executing in a computing device at a health care providers location comprising:

a patient interface driving a display device;

a biometric signature device coupled to the patient interface and providing biometric signature data to the patient interface;

processes executing in the computing device for causing the patient interface to prompt a patient to use the biometric signature device;

processes executing in the computing device for capturing the biometric signature data; and

processes executing in the computing device for communicating the biometric signature data together with information identifying the health care provider location to an external data processing service.

27. The practice management software of claim 26 further comprising a data cache coupled to the patient interface and the processes for communicating and operable to store biometric signature data such that the processes for communicating can operate asynchronously with respect to the processes for capturing the biometric signature data.

28. The practice management software of claim 26 wherein the biometric signature device comprises a fingerprint scanner.

29. The practice management software of claim 26 further comprising a user input device for entering user identification information.

30. A system for recording the location of a particular person at a particular place and time comprising:

a biometric signature device operable to capture a biometric signature of a particular person;

a clock generating an indication of a time at which the biometric signature was captured; and

an interface configured to communicate the biometric signature and the indication of the time at which the biometric signature was captured for storage at a remote location.

31. The system of claim 30 further comprising:

location information stored within the system, wherein the interface is configured to communicate the location information together with the biometric signature and clock information for storage at a remote location.

32. Biometric event recording software including processes executing in a computing device at a health care providers location comprising:

a biometric signature device coupled to provide biometric signature data;

processes executing in the computing device for prompting a person to use the biometric signature device;

processes executing in the computing device for capturing the biometric signature data; and

processes executing in the computing device for communicating the biometric signature data together with information identifying the health care provider location to an external data processing service.