Systems and Methods for Reducing Medical Claims Fraud
First Claim
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1. A method for reducing fraudulent use of a medical identity to obtain medical goods or services, comprising:
- receiving identification information for a medical insurance account of a medical consumer;
receiving medical claims data associated with the medical insurance account;
transmitting the medical claims data to the medical consumer; and
receiving a confirmation status from the medical consumer for the medical claims data.
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Abstract
Various embodiments of the present disclosure may be comprised of systems and methods for reducing fraudulent use of a medical identity to obtain medical goods or services. Identification information may be received for a medical insurance account of a medical consumer. Medical claims data associated with the medical insurance account may be received, and the medical claims data may be transmitted to the medical consumer. A confirmation status may be received from the medical consumer for the medical claims data.
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Citations
33 Claims
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1. A method for reducing fraudulent use of a medical identity to obtain medical goods or services, comprising:
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receiving identification information for a medical insurance account of a medical consumer; receiving medical claims data associated with the medical insurance account; transmitting the medical claims data to the medical consumer; and receiving a confirmation status from the medical consumer for the medical claims data. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16)
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17. A method for reducing fraudulent use of a medical identity to obtain medical goods or services, comprising:
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receiving identification information for a medical insurance account of a medical consumer; receiving medical claims data associated with the medical insurance account; applying analytics to the medical claims data; requesting verification of the medical claims data from the medical consumer when the analytics indicate an abnormality; and receiving a response to the verification request from the medical consumer. - View Dependent Claims (18, 19)
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20. A method for reducing fraudulent use of a medical identity to obtain medical goods or services, comprising:
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receiving medical claims data associated with a provider of medical goods or services, the medical claims data comprising medical claims made to a provider of medical insurance; applying analytics to the medical claims data; and notifying the provider of medical insurance when the analytics indicate an abnormality. - View Dependent Claims (21)
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22. A method for reducing fraudulent use of a medical identity to obtain medical goods or services, comprising:
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developing a database of medical insurance account information for a plurality of medical consumers, the database comprising a fraud alert status of each medical insurance account; receiving a request from a provider of medical goods or services for the fraud alert status of the medical insurance account of a medical consumer; and sending enhanced medical consumer identification information to the provider of the medical goods or services when a fraud alert has been associated with the medical insurance account. - View Dependent Claims (23, 24, 25)
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26. A system for reducing fraudulent use of a medical identity to obtain medical goods or services, comprising:
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a central processing unit (CPU) operatively connected to memory; and code stored by the memory causing the CPU to perform the following steps; receive identification information for a medical insurance account of a medical consumer; receive medical claims data associated with the medical insurance account; transmit the medical claims data to the medical consumer; receive a confirmation status from the medical consumer for the medical claims data; and transmit the confirmation status to a provider of the medical insurance account. - View Dependent Claims (27, 28)
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29. A non-transitory computer readable storage medium having embodied thereon a program, the program being executed by a processor to perform a method for reducing fraudulent use of a medical identity to obtain medical goods or services, the method comprising:
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receiving identification information for a medical insurance account of a medical consumer; receiving medical claims data associated with the medical insurance account; transmitting the medical claims data to the medical consumer; receiving a confirmation status from the medical consumer for the medical claims data; and transmitting the confirmation status to a provider of the medical insurance account. - View Dependent Claims (30, 31, 32, 33)
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Specification