Medical claims fraud prevention system including patient identification interface feature and associated methods

• US 8,392,212 B2
• Filed: 07/08/2010
• Issued: 03/05/2013
• Est. Priority Date: 07/28/2005
• Status: Active Grant

• 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:
  US12/832,458
• Publication Number:
  US 20100274582A1
• Time in Patent Office: 971 Days
• Field of Search: 705/2, 705/16, 364/406, 235/382
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A medical claim fraud prevention system includes a first controller positioned at a medical facility and including a user interface and a second controller positioned at a patient information collection center and adapted to be in communication with the first controller. The first controller may send a first signal to the second controller responsive to an occurrence of a predetermined event. The second controller may request identification information from a patient in response to the first signal received from the first controller, and the patient may enter the identification information using the user interface in communication with the second controller to verify their location. The second controller may transmit an indication to the first controller in response to the first signal received from the first controller regarding whether the patient is within a predetermined vicinity of the medical facility based on the identification information entered by the user using the user interface to verify their location.

Claims

1. A patient identity verification system comprising:

a first controller positioned at a medical facility and including a user interface;

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;

wherein the medical software system prompts a user to enter medical information related to a patient;

wherein the first controller sends a signal to the second controller response to the medical information received from the medical software system;

wherein the second controller requests identification information in response to the signal received from the first controller;

wherein the second controller receives identification information from the user interface, the identification information providing an indication of the patient'"'"'s location;

wherein the second controller transmits an indication to the first controller in response to the signal received from the first controller regarding whether the patient is within a vicinity of the medical facility based on the determination as to whether the identification information received from the user interface properly identifies the patient and indicates the patient'"'"'s location being within a vicinity of the medical facility.

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 identification information is a personal identification number.

5. 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.

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

7. 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.

8. A system according to claim 7 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 is within the vicinity of the medical facility.

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

10. A system according to claim 9 wherein the backup event that activates the backup locating system is an indication from the second controller that the patient is not within the vicinity of the medical facility based on the identification information entered by the patient to verify their location.

11. A system according to claim 9 wherein the action is at least one of calling the patient'"'"'s mobile telephone and speaking with the patient to determine the location of the patient, 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.

12. A system according to claim 9 wherein the action is calling the medical facility and requiring the patient to verify their location using a patient identifier.

13. A system according to claim 9 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.

14. A method of verifying the identity of a patient, the method comprising:

prompting a user to enter medical information related to a patient using a medical software system;

transmitting the medical information received by the medical software system to a first controller positioned at a medical facility that includes a user interface, the first controller being positioned in communication with the medical software system

transmitting a signal from the first controller to a second controller positioned at a patient information collection center responsive to medical information received by the first controller, the second controller being positioned in communication with the first controller, and the first controller being positioned in communication with the user interface;

requesting identification information via the user interface in response to the signal received from the first controller;

receiving identification information from the user interface, the identification information providing an indication of the patient'"'"'s location;

transmitting an indication from the second controller to the first controller regarding whether the patient is within a vicinity of the medical facility based on the determination as to whether the identification information received from the user interface properly identifies the patient and indicates the patient'"'"'s location being within a vicinity of the medical facility.

15. A method according to claim 14 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.

16. A method according to claim 15 wherein the first controller is a patient information unit reader adapted to read the patient information associated with the patient information unit.

17. A method according to claim 14 wherein the identification information is a personal identification number.

18. A method according to claim 14 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.

19. A method according to claim 14 wherein the patient information collection center is associated with processing health insurance claims.

20. A method according to claim 14 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.

21. A method according to claim 20 further comprising transmitting a signal from the second controller transmits 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 is within the vicinity of the medical facility.

22. A method according to claim 14 further comprising activating a backup locating system to perform a action based on a backup event.

23. A method according to claim 22 wherein the backup event that activates the backup locating system is an indication received from the second controller that the patient is not within the vicinity of the medical facility.

24. A method according to claim 22 wherein the action is at least one of calling the patient'"'"'s mobile telephone and speaking with the patient to determine the location of the patient, 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.

25. A method according to claim 22 wherein the action is calling the medical facility and requiring the patient to verify their location using a patient identifier.

26. A method according to claim 22 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.