SYSTEMS AND METHODS FOR IDENTIFYING FRAUD IN TRANSACTIONS COMMITTED BY A COHORT OF FRAUDSTERS
First Claim
1. A computer-implemented method for processing applications to provide publicly-funded health benefits, the method comprising:
- searching, by the computer, a first database storing one or more prior applicants associated with one or more characteristics;
identifying, by the computer, one or more associates of a new applicant having one or more characteristics of the prior applicants in the first database, wherein an associate is a prior applicant having one or more relationships to the new applicant based upon one or more characteristics common with the new applicant;
identifying, by the computer, one or more indicators of fraud in the first database associated with one or more people in a cohort comprising the new applicant and the one or more associates;
assigning, by the computer, a weight to each of the identified indicators of fraud using a classification model; and
calculating, by the computer, a risk score for the new applicant using each of the weights assigned to the one or more identified fraud indicators.
4 Assignments
0 Petitions
Accused Products
Abstract
Disclosed are systems and methods for identifying potential fraud committed by a cohort of people using models for identifying relationships among people to build the cohort and using fraud models to identify indicators of frauds from attributes of people. Embodiments may predict a likelihood applicants seeking privileges to distribute governmental benefits by identifying members of a cohort associated with an applicant, assigning a value to the strengths of the relationships between people in the cohort, determining weights for identified indicators of fraud identified using fraud models, determining a risk score for the cohort using the values and data points, and then performing a clustering analysis for the risk score of the cohort to determine a risk factor for fraud committed by the applicant and the cohort.
14 Citations
18 Claims
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1. A computer-implemented method for processing applications to provide publicly-funded health benefits, the method comprising:
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searching, by the computer, a first database storing one or more prior applicants associated with one or more characteristics; identifying, by the computer, one or more associates of a new applicant having one or more characteristics of the prior applicants in the first database, wherein an associate is a prior applicant having one or more relationships to the new applicant based upon one or more characteristics common with the new applicant; identifying, by the computer, one or more indicators of fraud in the first database associated with one or more people in a cohort comprising the new applicant and the one or more associates; assigning, by the computer, a weight to each of the identified indicators of fraud using a classification model; and calculating, by the computer, a risk score for the new applicant using each of the weights assigned to the one or more identified fraud indicators. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A benefits provider application system configured to mitigate fraud by a cohort, the system comprising:
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a provider application database storing in memory one or more applications received from one or more prior applicants seeking to distribute a government benefit, wherein each prior applicant is associated with one or more attributes; and a server comprising a processor configured to; receive a new application from a new applicant having one or more attributes; identify one or more associates having a relationship with the new applicant from the one or more prior applicants, wherein the relationship between an associate and the new applicant is based upon one or more common attributes; identify one or more indicators of fraud for the new applicant and each of the one or more associates using one or more fraud models identifying a set of one or more attributes as being indicators of fraud; and determine a risk factor for the new applicant based upon a risk score determined by the one or more indicators of fraud identified for the new applicant and each of the one or more associates. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18)
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Specification