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System and method for implementing healthcare fraud countermeasures

  • US 7,421,398 B2
  • Filed: 03/19/2007
  • Issued: 09/02/2008
  • Est. Priority Date: 01/22/2003
  • Status: Expired due to Fees
First Claim
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1. A method of discouraging phantom billing healthcare fraud comprising:

  • providing a health care service;

    in conjunction with providing said health care service at a particular location to a patient, causing said patient to provide a biometric signature;

    capturing said biometric signature;

    creating an event record that records said patient was at said particular location at a particular time and/or date, said event record consisting of a patient identifier, said biometric signature, and location information indicating said particular location at which said biometric signature is obtained and at which said health care service is provided and said event record indicates the absence of phantom billing, wherein said event record is created using a computer system;

    storing said record in a computerized data store, wherein said record corresponds to reimbursement information and said location information in said record provides evidence that a particular patient was at a suitable location for providing said healthcare services;

    providing an interface to said computerized data store wherein said interface receives said reimbursement information and determines whether a record in said computerized data store matches said reimbursement information;

    determining whether said record corresponds to said reimbursement information wherein the absence of a positive match indicates a phantom bill;

    indicating to a payer entity whether said particular patient was at a suitable location for providing said healthcare services based on said determination.

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