Systems and methods for assessing the potential for fraud in business transactions
First Claim
1. A method, comprising:
- providing at least one request data element for at least one request to a computer system;
assessing at least one fraud potential indicator for the at least one request based on at least two of;
a) at least one comparison of the at least one request data element to a datum in a database;
b) at least one comparison of the at least one request data element to at least one fraud model; and
c) at least one business rule applied to the at least one request data element;
wherein the at least one fraud potential indicator comprises an estimate of a probability of fraud in the at least one request.
1 Assignment
0 Petitions
Accused Products
Abstract
Methods and systems are provided for assessing the potential for fraud of an insurance claim. In some embodiments, request data may be provided to a computer system. In some embodiments, at least one fraud potential indicator may be assessed to the request data from at least one comparison of at least one request data element to at least one fraud model. In some embodiments, a fraud potential indicator may be an estimate of the potential for fraud in an insurance claim. In some embodiments, at least one fraud potential indicator for request data may be assessed based on at least one comparison of at least one request data element to additional insurance data. Some embodiments may include assessing at least one fraud potential indicator for request data based on at least one fraud potential indicator.
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Citations
66 Claims
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1. A method, comprising:
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providing at least one request data element for at least one request to a computer system;
assessing at least one fraud potential indicator for the at least one request based on at least two of;
a) at least one comparison of the at least one request data element to a datum in a database;
b) at least one comparison of the at least one request data element to at least one fraud model; and
c) at least one business rule applied to the at least one request data element;
wherein the at least one fraud potential indicator comprises an estimate of a probability of fraud in the at least one request. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41)
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42. A computer system, comprising:
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a CPU; and
a memory coupled to the CPU, wherein the memory is configured to store at least one computer program executable by the CPU, and wherein at least one computer program is executable to;
provide at least one request data element for at least one request to the computer system;
assess at least one fraud potential indicator for the at least one request based on at least two of;
a) at least one comparison of the at least one request data element to data in a database;
b) at least one comparison of the at least one request data element to at least one fraud model; and
c) at least one business rule applied to the at least one request data element;
wherein the at least one fraud potential indicator comprises an estimate of a probability of fraud in a request. - View Dependent Claims (43, 44, 45, 46, 47)
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48. A carrier medium comprising program instructions, wherein the program instructions are computer-executable to implement a method comprising:
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providing at least one request data element for at least one request to a computer system;
assessing at least one fraud potential indicator for the at least one request based on at least two of;
a) at least one comparison of the at least one request data element to data in a database;
b) at least one comparison of the at least one request data element to at least one fraud model; and
c) at least one business rule applied to the at least one request data element;
wherein the at least one fraud potential indicator comprises an estimate of a probability of fraud in the at least one request. - View Dependent Claims (49, 50, 51, 52, 53)
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54. A method, comprising:
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assessing at least one fraud potential indicator for a plurality of insurance claims using at least one fraud potential detection technique; and
defining a minimum referral fraud potential indicator such that a desired quantity of requests are referred. - View Dependent Claims (55, 56, 57, 58, 59, 60, 61)
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62. A system configured to estimate liability, comprising:
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a CPU; and
a memory coupled to the CPU, wherein the memory is configured to store at least one computer program executable by the CPU, and wherein at least one computer program is executable to;
assess fraud potential indicators for a plurality of requests using at least one fraud potential detection technique; and
establish a minimum referral fraud potential indicator such that a desired quantity of requests are referred. - View Dependent Claims (63)
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64. A carrier medium comprising program instructions, wherein the program instructions are computer-executable to implement a method comprising:
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assessing a fraud potential indicator for a plurality of requests using at least one fraud potential detection technique; and
establishing a minimum referral fraud potential indicator such that a desired quantity of requests are referred. - View Dependent Claims (65)
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66-157. -157. (canceled)
Specification