MEDICAL CLAIMS FRAUD PREVENTION SYSTEM AND ASSOCIATED METHODS

• US 20100280843A1
• Filed: 07/08/2010
• Published: 11/04/2010
• Est. Priority Date: 07/28/2005
• Status: Active Grant

• Current Assignee: Beraja IP LLC
• Original Assignee: IBEZA, LLC
• Inventors: Beraja, Victor, Beraja, Esther, Beraja, Matilde, Beraja, Roberto, Beraja, Isidoro
• Granted Patent: US 8,392,210 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G01S 5/0027 of actual mobile position, i.e. position determined on mobile
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: H04L 67/52 specially adapted for the location of the user terminal
• CPC Class Codes: H04W 4/02 Services making use of location information
• CPC Class Codes: H04W 4/029 Location-based management or tracking services

Abstract

A medical claim fraud prevention system includes a first controller positioned at a medical facility, a second controller positioned at a patient information collection center and adapted to be in communication with the first controller, and a patient locating device adapted to be within a predetermined vicinity of a patient and adapted to be in communication with the second controller to provide location data relating to the location of the patient locating device. The first controller may a first signal to the second controller responsive to an occurrence of a predetermined event. The second controller may transmit an indication to the first controller in response to the first signal received from the first controller of whether the patient locating device is within a predetermined vicinity of the medical facility based on the location data relating to the location of the patient locating device.

Claims

1. A medical claim fraud prevention system comprising:

a first controller positioned at a medical facility;

a second controller positioned at a patient information collection center and adapted to be in communication with the first controller;

a patient locating device adapted to be within a predetermined vicinity of a patient and adapted to be in communication with the second controller to provide location data relating to the location of the patient locating device;

wherein the first controller sends a first signal to the second controller responsive to an occurrence of a predetermined event;

wherein the second controller transmits an indication to the first controller in response to the first signal received from the first controller of whether the patient locating device is within a predetermined vicinity of the medical facility based on the location data relating to the location of the patient locating device.

2. A system according to claim 1 wherein the patient is assigned a patient information unit having predetermined patient information associated therewith;

and wherein the predetermined event is reading information from the patient information unit.

3. A system according to claim 2 wherein the first controller is a patient information unit reader adapted to read the predetermined patient information associated with the patient information unit.

4. A system according to claim 1 wherein a medical software system in communication with the first controller is used by a medical professional at the medical facility;

wherein the medical professional is prompted to enter information relating to the patient using the medical software system; and

wherein the predetermined event is entry of the information relating to the patient using the medical software system.

5. A system according to claim 1 wherein a billing system is used at the medical facility to bill for medical services provided to the patient;

and wherein the predetermined event is use of the billing system with respect to the patient.

6. A system according to claim 1 wherein the patient locating device is a GPS enabled electronic device.

7. A system according to claim 1 wherein the patient locating device is a signal emitting device capable of being triangulated to determine the location data.

8. A system according to claim 1 wherein the medical facility is at least one of a doctor'"'"'s office, a hospital, a pharmacy, a therapy center, a medical laboratory, a medical clinic, a rehabilitation facility, a dialysis unit, an outpatient center, an assisted care living facility, an emergency room and a nursing home.

9. A system according to claim 1 wherein the patient information collection center is associated with processing health insurance claims.

10. A system according to claim 1 wherein the signal transmitted from the first controller to the second controller includes information relating to a claim for reimbursement relating to medical services being provided to the patient at the medical facility.

11. A system according to claim 10 wherein the second controller transmits a signal to the first controller including an indication of whether or not the claim is a valid claim based on the indication of whether the patient locating device is within the predetermined vicinity of the medical facility.

12. A system according to claim 1 further comprising a backup locating system that is activated to perform a predetermined action based on a predetermined backup event.

13. A system according to claim 12 wherein the predetermined backup event that activates the backup locating system is an indication received from the second controller that the patient locating device is not within the predetermined vicinity of the medical facility.

14. A system according to claim 12 wherein the locating device is a mobile telephone;

and wherein the predetermined action is calling the mobile telephone and speaking with the patient to determine the location of the patient.

15. A system according to claim 12 wherein the predetermined action is at least one of calling the medical facility and requiring the patient to verify their location using a predetermined patient identifier, and providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient'"'"'s location.

16. A system according to claim 12 wherein the predetermined action is calling the medical facility and speaking with the patient, and requiring the patient to verify their location using a predetermined patient identifier.

17. A method of preventing medical claim fraud, the method comprising:

transmitting a first signal from a first controller positioned at a medical facility to a second controller positioned at a patient information collection center responsive to an occurrence of a predetermined event, wherein the second controller is adapted to be in communication with a patient locating device and wherein the patient locating device is adapted to be within a predetermined vicinity of a patient and provides location data relating to the location of the patient locating device; and

transmitting an indication from the second controller to the first controller in response to the first signal received from the first controller of whether the patient locating device is within a predetermined vicinity of the medical facility based on the location data relating to the location of the patient locating device.

18. A method according to claim 17 wherein the patient is assigned a patient information unit having predetermined patient information associated therewith;

and wherein the predetermined event is reading information from the patient information unit.

19. A method according to claim 18 wherein the first controller is a patient information unit reader adapted to read the predetermined patient information associated with the patient information unit.

20. A method according to claim 17 wherein a medical software system in communication with the first controller is used by a medical professional at the medical facility;

wherein the medical professional is prompted to enter information relating to the patient using the medical software system; and

wherein the predetermined event is entry of the information relating to the patient using the medical software system.

21. A method according to claim 17 wherein a billing system is used at the medical facility to bill for medical services provided to the patient;

and wherein the predetermined event is use of the billing system with respect to the patient.

22. A method according to claim 17 wherein the patient locating device is a GPS enabled electronic device.

23. A method according to claim 17 wherein the patient locating device is a signal emitting device capable of being triangulated to determine the location data.

24. A method according to claim 17 wherein the medical facility is at least one or a doctors office, a hospital, a pharmacy, a therapy center, a medical laboratory, a medical clinic, a rehabilitation facility, a dialysis unit, an outpatient center, an assisted care living facility, an emergency room and a nursing home.

25. A method according to claim 17 wherein the patient information collection center is associated with processing health insurance claims.

26. A method according to claim 17 wherein the signal transmitted from the first controller to the second controller includes information relating to a claim for reimbursement relating to medical services being provided to the patient at the medical facility.

27. A method according to claim 26 further comprising transmitting a signal from the second controller to the first controller including an indication of whether or not the claim is a valid claim based on the indication of whether the patient locating device is within the predetermined vicinity of the medical facility.

28. A method according to claim 17 further comprising activating a backup locating system to perform a predetermined action based on a predetermined backup event.

29. A method according to claim 28 wherein the predetermined backup event that activates the backup locating system is an indication received from the locating device that the locating device is not within the predetermined vicinity of the medical facility.

30. A method according to claim 28 wherein the patient locating device is a mobile telephone;

and wherein the predetermined action is calling the mobile telephone and speaking with the patient to determine the location of the patient.

31. A method according to claim 28 wherein the predetermined action is at least one of calling the medical facility and requiring the patient to verify their location using a predetermined patient identifier, and providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient'"'"'s location.

32. A method according to claim 28 wherein the predetermined action is calling the medical facility and speaking with the patient, and requiring the patient to verify their location using a predetermined patient identifier.