SYSTEM AND METHOD FOR IMPLEMENTING HEALTHCARE FRAUD COUNTERMEASURES

• US 20070260484A1
• Filed: 03/19/2007
• Published: 11/08/2007
• Est. Priority Date: 01/22/2003
• Status: Active Grant

• Current Assignee: Scott Kimmel
• Original Assignee: Scott Kimmel
• Inventors: Kimmel, Scott
• Granted Patent: US 7,421,398 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

4-1. The method of claim 1 further comprising obtaining a biometric signature at least twice during said provision of health care services.

5-2. The method of claim 1 further comprising:

receiving a claim for reimbursement for said health care services;

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

matching said claim for reimbursement to an event record for a particular patient to determine whether said one or more event records indicate that said patient was at a suitable location for reimbursing said health care services; and

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

11. A biometric audit trail system comprising:

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

a biometric record consisting of said biometric information and said location identification;

a data storage system for storing said biometric record with a plurality of other biometric records; and

processes for retrieving biometric records at a later time and/or date from said data storage system to audit locations visited by particular persons.

12. The system of claim 11 further comprising processes operable to analyze said retrieved biometric records to identify patterns amongst a plurality of biometric records.

13. The system of claim 11 wherein said biometric record further comprises a timestamp indicating a time and/or date at which said biometric information was obtained.

14. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of said biometric signature and location information indicating said particular location at which said biometric signature is obtained and at which said health care service is provided wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

15. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of a patient identifier, said biometric signature, and at least one timestamp indicating a time and/or date at which said biometric signature is obtained and at which said health care service is provided, wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

16. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of said biometric signature and at least one timestamp indicating a time and/or date at which said biometric signature is obtained and at which said health care service is provided and said event record indicates the absence of phantom billing, wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

17. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of a patient identifier, said biometric signature, at least one timestamp, and location information indicating said particular location at which said biometric signature is obtained and at which said health care service is provided wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

18. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of a patient identifier, said biometric signature, at least two timestamps indicating a range of times at which said health care service was provided, and location information indicating said particular location at which said biometric signature is obtained and at which said health care service is provided and said event record indicates the absence of phantom billing, wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

19. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of a patient identifier, said biometric signature, metadata, and location information indicating said particular location at which said biometric signature is obtained and at which said health care service is provided and said event record indicates the absence of phantom billing, wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

20. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of said biometric signature, location information, and at least one timestamp indicating a time and/or date at which said biometric signature is obtained and at which said health care service is provided, wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.

21. A method of discouraging phantom billing healthcare fraud comprising:

providing a health care service;

in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

capturing said biometric signature;

creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of said biometric signature, location information indicating a location at which said biometric signature is obtained and at which said health care service is provided, wherein said event record is created using a computer system;

transmitting said event record including said biometric signature to a computerized data store that is accessible by a payer entity; and

storing said event record in said computerized data store.