SYSTEM AND METHOD FOR PREVENTING HEALTH CARE FRAUD
First Claim
1. A method for preventing health care fraud, comprising the steps of:
- (a) storing, in a central repository, a first biometric signature received from an insurance recipient during an enrollment period;
(b) storing, in said central repository, a first set of demographic information received from said insurance recipient during said enrollment period and associating said first set of demographic information with said first biometric signature;
(c) receiving, during a visit to a health care provider, a second biometric signature and a second set of demographic information from a patient, wherein said visit to said health care provider occurs after said enrollment period;
(d) retrieving said first biometric signature and said first set of demographic information from said central repository;
(e) comparing said first biometric signature to said second biometric signature, and comparing at least a portion of said first set demographic information to at least a portion of said second set of demographic information; and
(f) creating an encounter record in said central repository, wherein said encounter records comprises a flag indicating the results the comparisons made in step (e);
whereas the identity of said patient as said insurance recipient and eligibility to receive health care from said health care provider may be verified prior to an insurance claim related to said visit is processed.
0 Assignments
0 Petitions
Accused Products
Abstract
Systems, methods and computer program products for discouraging and preventing health care-related insurance fraud are disclosed. In an aspect, an insured (e.g., Medicaid) beneficiary identity validation eligibility verification tool is provided that identifies Medicaid beneficiaries using biometrics and verifies their Medicaid eligibility electronically each time they visit a health care provider who participates in the Medicaid program. In such an aspect, an electronic encounter record is created between the provider and the validated and verified beneficiary each time health care services are rendered. The tool of the present invention thus enables insurance companies, regulatory bodies and the like to match submitted claims to captured encounter records as proof that the beneficiary did visit the provider in question on the reported date of service.
-
Citations
18 Claims
-
1. A method for preventing health care fraud, comprising the steps of:
-
(a) storing, in a central repository, a first biometric signature received from an insurance recipient during an enrollment period; (b) storing, in said central repository, a first set of demographic information received from said insurance recipient during said enrollment period and associating said first set of demographic information with said first biometric signature; (c) receiving, during a visit to a health care provider, a second biometric signature and a second set of demographic information from a patient, wherein said visit to said health care provider occurs after said enrollment period; (d) retrieving said first biometric signature and said first set of demographic information from said central repository; (e) comparing said first biometric signature to said second biometric signature, and comparing at least a portion of said first set demographic information to at least a portion of said second set of demographic information; and (f) creating an encounter record in said central repository, wherein said encounter records comprises a flag indicating the results the comparisons made in step (e); whereas the identity of said patient as said insurance recipient and eligibility to receive health care from said health care provider may be verified prior to an insurance claim related to said visit is processed. - View Dependent Claims (2, 3, 4, 5, 6)
-
-
7. A computer program product comprising a computer usable medium having control logic stored therein for causing a computer to facilitate the prevention of health care fraud, said control logic comprising:
-
first computer readable program code means for causing the computer to store, in a central repository, a first biometric signature received from an insurance recipient during an enrollment period; second computer readable program code means for causing the computer to store, in said central repository, a first set of demographic information received from said insurance recipient during said enrollment period and associating said first set of demographic information with said first biometric signature; third computer readable program code means for causing the computer to receive, during a visit to a health care provider, a second biometric signature and a second set of demographic information from a patient, wherein said visit to said health care provider occurs after said enrollment period; fourth computer readable program code means for causing the computer to retrieve said first biometric signature and said first set of demographic information from said central repository; fifth computer readable program code means for causing the computer to compare said first biometric signature to said second biometric signature, and compare at least a portion of said first set demographic information to at least a portion of said second set of demographic information; and sixth computer readable program code means for causing the computer to create an encounter record in said central repository; whereas the identity of said patient as said insurance recipient and eligibility to receive health care from said health care provider may be verified prior to an insurance claim related to said visit is processed. - View Dependent Claims (8, 9, 10, 11, 12)
-
-
13. A system for preventing health care fraud, comprising:
-
(a) at least one central repository capable of storing; a first biometric signature received from an insurance recipient during an enrollment period; and a first set of demographic information received from said insurance recipient during said enrollment period and associating said first set of demographic information with said first biometric signature; and (b) at least one web server, coupled to said at least one central repository, configured to; receive, during a visit to a health care provider, a second biometric signature and a second set of demographic information from a patient, wherein said visit to said health care provider occurs after said enrollment period; retrieve said first biometric signature and said first set of demographic information from said at least one central repository; compare said first biometric signature to said second biometric signature; compare at least a portion of said first set demographic information to at least a portion of said second set of demographic information; and create an encounter record in said at least one central repository, wherein said encounter records comprises a flag indicating the results the comparisons made by said at least one web server; whereas the identity of said patient as said insurance recipient and eligibility to receive health care from said health care provider may be verified prior to an insurance claim related to said visit is processed. - View Dependent Claims (14, 15, 16, 17, 18)
-
Specification