Medical claims fraud prevention system and associated methods

• US 8,392,210 B2
• Filed: 07/08/2010
• Issued: 03/05/2013
• Est. Priority Date: 07/28/2005
• Status: Expired due to Fees

• Current Assignee: Beraja IP LLC
• Original Assignee: Beraja IP LLC
• Inventors: Beraja, Roberto, Beraja, Victor, Beraja, Esther, Beraja, Isidoro, Beraja, Matilde
• Primary Examiner(s): PAULS, JOHN A
• Application Number:
  US12/832,354
• Publication Number:
  US 20100280843A1
• Time in Patent Office: 971 Days
• Field of Search: 705/2, 705/3, 705/16, 379/96, 235/382
• 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 medical software system adapted to be in communication with the first controller; and

a GPS-enabled patient locating device adapted to be within a 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 medical software system is configured to prompt a user to enter medical information related to the patient, the medical information comprising at least one of medical observations, diagnoses, medical conditions, previous medical treatments, and prescriptions;

wherein the medical software system is configured to send medical information related to the patient to the first controller;

wherein the first controller is configured to send a signal requesting the location of the patient locating device to the second controller responsive to the medical information received from the medical software system; and

wherein the second controller is configured to transmit an indication to the first controller in response to the signal received from the first controller indicating whether the patient locating device is within a vicinity of the medical facility based on the GPS 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 patient information associated therewith;

and wherein the 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 patient information associated with the patient information unit.

4. A system according to claim 1 wherein the medical software system is at least one of a billing system and a patient information collection system.

5. 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.

6. 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.

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

8. 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.

9. A system according to claim 8 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 vicinity of the medical facility.

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

11. A system according to claim 10 wherein the 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 vicinity of the medical facility.

12. A system according to claim 10 wherein the patient locating device is a mobile telephone;

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

13. A system according to claim 10 wherein the action is at least one of calling the medical facility and requiring the patient to verify their location using a 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.

14. A system according to claim 10 wherein the action is calling the medical facility and speaking with the patient, and requiring the patient to verify their location using a patient identifier.

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

prompting a user to enter medical information related to a patient into a medical software system positioned at a medical facility, the medical information comprising at least one of medical observations, diagnoses, medical conditions, previous medical treatments, and prescriptions;

transmitting the medical information related to the patient from the medical software system to a first controller positioned at the medical facility and in communication with the medical software system;

transmitting a signal including a request for the location of a patient locating device associated with the patient from the first controller to a second controller positioned at a patient information collection center responsive to the medical information related to the patient received from the medical software system, wherein the second controller is adapted to be in communication with the patient locating device and wherein the patient locating device is adapted to be within a vicinity of the 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 responsive to the signal received from the first controller indicating whether the patient locating device is within a vicinity of the medical facility based on the location data relating to the location of the patient locating device.

16. A method according to claim 15 wherein the patient is assigned a patient information unit having patient information associated therewith;

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

17. A method according to claim 16 wherein the first controller is a patient information unit reader adapted to read the patient information associated with the patient information unit.

18. A method according to claim 15 wherein the medical software system at least one of a billing system and a patient information collection system.

19. A method according to claim 15 wherein the patient locating device is a signal emitting device capable of being triangulated to determine the location data.

20. A method according to claim 15 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.

21. A method according to claim 15 wherein the patient information collection center is associated with processing health insurance claims.

22. A method according to claim 15 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.

23. A method according to claim 22 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 vicinity of the medical facility.

24. A method according to claim 15 further comprising activating a backup locating system to perform an action based on a backup event.

25. A method according to claim 24 wherein the backup event that activates the backup locating system is an indication received from the locating device that the locating device is not within the vicinity of the medical facility.

26. A method according to claim 24 wherein the patient locating device is a mobile telephone;

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

27. A method according to claim 24 wherein the action is at least one of calling the medical facility and requiring the patient to verify their location using a 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.

28. A method according to claim 24 wherein the action is calling the medical facility and speaking with the patient, and requiring the patient to verify their location using a patient identifier.