Medical claims fraud prevention system including historical patient locating feature and associated methods

• US 8,392,213 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:
  US12/832,500
• Publication Number:
  US 20100274583A1
• Time in Patent Office: 971 Days
• Field of Search: 705/2, 705/16, 705/30, 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
• 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 and a second controller positioned at a patient information collection center and adapted to be in communication with a data center having historical location information relating to a patient locating device. The first controller may transmit 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 regarding the historical location of the patient locating device and whether the patient locating device was within a predetermined vicinity of the medical facility during a predetermined time period.

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 a data center having historical location information relating to a patient locating device associated with a patient; and

a medical software system adapted to be in communication with the first controller;

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 a historical 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 regarding the historical location of the patient locating device and whether the patient locating device was within a vicinity of the medical facility during a time period.

2. 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.

3. A system according to claim 1 wherein the patient locating device is a GPS enabled mobile telephone.

4. A system according to claim 1 wherein the patient locating device is a signal transmitting device capable of being triangulated to determine location data.

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 locating device was within the vicinity of the medical facility during the time period.

9. A system according to claim 1 further comprising a backup locating system that is activated to perform an 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 received from the second controller that the patient locating device was not within the vicinity of the medical facility during the time period.

11. A system according to claim 9 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 if the patient was within the vicinity of the medical facility during the time period.

12. A system according to claim 9 wherein the action is sending the patient an email that requests entry of information to verify if the patient was within the vicinity of the medical facility during the time period.

13. A system according to claim 9 wherein the action is sending correspondence to the patient that requests verification of whether the patient was within the vicinity of the medical facility during the time period.

14. 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 requesting a historical 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 receiving the medical information related to the patient from the medical software system, wherein the second controller is adapted to be in communication with a data center having historical location information relating to the patient locating device; and

transmitting an indication from the second controller to the fist controller responsive to the signal received from the first controller requesting the historical location of the patient locating device and indicating whether the patient locating device was within a vicinity of the medical facility during a time period.

15. A method according to claim 14 wherein the medical software system is at least one of a billing system and a patient information collection system.

16. A method according to claim 14 wherein the patient locating device is a GPS enabled mobile telephone.

17. A method according to claim 14 wherein the patient locating device is a signal transmitting device capable of being triangulated to determine location data.

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 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 was within the vicinity of the medical facility during the time period.

22. A method according to claim 14 further comprising activating a backup locating system to perform an 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 locating device was not within the vicinity of the medical facility during the time period.

24. A method according to claim 22 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 if the patient was within the vicinity of the medical facility during the time period.

25. A method according to claim 22 wherein the action is sending the patient an email that requests entry of information to verify if the patient was within the vicinity of the medical facility during the time period.

26. A method according to claim 22 wherein the action is sending correspondence to the patient that requests verification of whether the patient was within the vicinity of the medical facility during the time period.