Cardless method for reducing fraud in healthcare programs

• US 7,058,585 B1
• Filed: 04/27/2004
• Issued: 06/06/2006
• Est. Priority Date: 05/05/2003
• Status: Active Grant

• Current Assignee: Access Security Protection LLC
• Original Assignee: Richard Glee Wood, Wesley Jack Jr. White
• Inventors: Wood, Richard Glee, White, Wesley Jack Jr.
• Primary Examiner(s): Thomas, Joseph
• Assistant Examiner(s): Gilligan, Christopher L
• Application Number:
  US10/832,529
• Time in Patent Office: 770 Days
• Field of Search: 705 2- 4, 902/26
• US Class Current: 705/4
• CPC Class Codes: G06F 21/32 using biometric data, e.g. fingerprints, iris scans or voiceprints
• CPC Class Codes: G06F 21/34 involving the use of external additional devices, e.g. dongles or smart cards
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

The method for reducing fraud in a healthcare program by registering a service provider with a healthcare provider and issuing a service provider identification code entails registering at least one service of the service provider with the private healthcare provider and identifying a claim code for each registered service; issuing a code based on data from a biometric reading, a keypad entry with a PIN code, or an electronic signature pad entry to an individual related to a benefits program of the healthcare provider; using the code to determine if the individual is eligible for the healthcare program and performing three transmissions of information to reduce fraud in the systems.

Claims

1. A method for reducing fraud in a healthcare program, wherein the method consists of the steps of:

a. registering a service provider with a healthcare provider and issuing a service provider identification code;

b. registering at least one service or at least one good of the service provider with the healthcare provider and identifying a claim code for each registered service or registered good;

c. issuing and storing a first individual identification code to a first individual related to the healthcare program, wherein the first individual identification code is linked to a biometric data of the first individual;

d. comparing second biometric data from a second individual against the first individual identification code to determine if the second individual is eligible for benefits from the healthcare program;

e. sending a first transmission from the service provider to the healthcare provider, wherein the first transmission comprises;

i. the service provider identification code;

ii. the individual identification code;

iii. proposed information selected from the group consisting of proposed product information for the second individual;

proposed service information for the second individual;

corresponding claim codes for the proposed product; and

corresponding claim codes for the proposed service; and

iv. a request to confirm;

1. the second individual'"'"'s eligibility for benefits under the healthcare program;

2. a validation that the proposed good or service is approved for the individual;

3. the service provider'"'"'s eligibility to render services or provide goods under the healthcare program; and

4. a request to participate in an accelerated payment program for the proposed good or the proposed service;

f. sending a second transmission from the healthcare provider to the service provider, wherein the second transmission comprises;

i. the second individual'"'"'s eligibility for benefits under the healthcare program;

ii. a validation that the proposed good or proposed service is approved for the second individual;

iii. a validation of the service provider'"'"'s eligibility to render services under the healthcare program;

iv. a confirmation that an accelerated payment program is available; and

v. providing an authorization code to provide the proposed product or proposed service;

g. sending a third transmission from the service provider to the healthcare provider, wherein the third transmission comprises of;

i. a claim codes list for services rendered;

ii. acknowledgement by the individual that information on the product or service was provided to the second individual;

iii. acknowledgement that the product or service has been received from the service provider; and

iv. a request for accelerated payment by the healthcare provider to the service provider.

2. The method of claim 1, wherein the second transmission further comprises an alert to the service provider that a portion of the funds may need to come from the individual and an indication of the amount of the funds.

3. The method of claim 1, wherein the third transmission further comprises dollar amount limits for the accelerated payment.

4. The method of claim 1, further comprising the step of wherein between zero and two days of receipt of the third transmission by the healthcare provider funds are transmitted from the healthcare provider to the service provider.

5. The method of claim 1, wherein the first transmission further comprises a member of the group consisting of:

a. a first transmission identification code;

b. service provider information that comprises a member of the group consisting of;

i. service provider code;

ii. service provider name;

iii. service provider address;

iv. service provider office code; and

v. service provider phone number;

c. individual information that comprises a member of the group consisting of;

i. individual name;

ii. individual address;

iii. private healthcare provider phone number;

iv. individual social security number; and

v. combinations thereof.

6. The method of claim 1, wherein the second transmission further comprises a member of the group consisting of:

a. a notice as to further services or goods potentially needed by the individual;

b. a depiction of the individual; and

c. a second transmission identification code and combinations thereof.

7. The method of claim 1, wherein the third transmission comprises of:

a. a tracking number;

b. a date on which the benefit was rendered;

c. a total amount charged relative to the individual;

d. a statement as to any amount that exceeds authorized service or good;

e. detail on the claim codes for rendered service or good;

f. a third transmission identification code; and

g. combinations thereof.

8. The method of claim 1, wherein the individual'"'"'s benefit history comprises information on length of time on private healthcare provider programs and types of other programs the individual is eligible to use.

9. The method of claim 1, further comprising the step of creating a contractual relationship between the healthcare provider and a third party for the benefit of the individual.

10. The method of claim 1, further comprising the step of using an electronic retrieval system, wherein the electronic retrieval system comprises a database that contains personal data for comparison purposes.

11. The method of claim 10, wherein the electronic retrieval system comprises a process selected from the group consisting of an internet query, an e-mail query, a network query, comparative information transfers, and combinations thereof.