Medical claims fraud prevention system including photograph records identification and associated methods

• US 8,583,454 B2
• Filed: 11/19/2012
• Issued: 11/12/2013
• 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
• Application Number:
  US13/680,928
• Publication Number:
  US 20130142400A1
• Time in Patent Office: 358 Days
• Field of Search: 705/2, 705/14, 705/75, 235/380, 348/156, 382/118, 713/186
• 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: G06Q 20/40145 Biometric identity checks
• 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 the first controller. The first controller may transmit a first signal to the second controller responsive to an occurrence of an event. The second controller may initiate contact with a photograph database via a network interface in response to the first signal received from the first controller, and an official photograph associated with the patient name may be identified. The second controller may transmit the official photograph to the first controller so that the official photograph is viewable on a user interface at the medical facility. A patient identity may be verified by performing a comparison of a patient with the official photograph of the patient.

Claims

1. A patient identity verification system comprising:

a first controller associated with a medical facility;

a memory associated with the first controller;

a second controller associated with an information collection center and adapted to be in communication with the first controller;

a network interface; and

a photograph database;

wherein the photograph database includes photographs that are verifiable as being associated with a patient, the photographs being defined as official photographs, and

wherein the photograph database is accessible using the network interface over a network;

wherein the first controller is configured to transmit a signal that includes a request for an official photograph associated with a patient to the second controller responsive to an occurrence of an event;

wherein the official photograph associated with the patient is identified within the photograph database;

wherein the second controller is configured to retrieve the official photograph from the photograph database and transmits the official photograph associated with the patient to the first controller responsive to the signal so that the official photograph is viewable on a user interface;

wherein a copy of the official photograph is stored on the memory to define a stored official photograph;

wherein the first controller is configured to facilitate verification that the stored official photograph remains an accurate depiction of the patient associated therewith after a period of time during which the physical appearance of the patient associated with the stored official photograph has changed by enabling the comparison of the stored official photograph to the current official photograph on the photograph database; and

wherein a patient identity is verified by the performance of a comparison of the official photograph of the patient with the physical appearance of an individual purporting to be the patient.

2. A system according to claim 1, wherein the patient is assigned a patient information unit having patient information associated therewith, and wherein a patient information unit reader is configured to read the patient information from the patient information unit and be in communication with the first controller.

3. A system according to claim 2, wherein the patient information unit reader is integrally formed with the first controller.

4. A system according to claim 2 wherein the patient information unit is a credit card or a debit card.

5. A system according to claim 1 wherein a software system in communication with the first controller is operable by an operator at the medical facility;

wherein the operator is prompted to enter information relating to the patient using the software system; and

wherein the event is entry of the information relating to the patient via the software system.

6. A system according to claim 1, further comprising a billing system associated with the first controller, wherein the event is entry of information associated with the patient in the billing system.

7. A system according to claim 1, wherein the first controller transmits an indication signal to the second controller indicating whether the identity of the patient is verified;

and wherein the second controller transmits a validation signal to the first controller in response to the indication signal.

8. A system according to claim 1 further comprising an image capturing device in communication with the first controller to capture an image of the patient;

wherein a facial recognition program performs a comparison between the image of the patient and the official photograph associated with the patient, and wherein the comparison by the facial recognition program is performed by at least one of the first controller, second controller, and a remote computerized device.

9. A system according to claim 8, wherein the comparison by the facial recognition program is performed by at least two of the first controller, second controller, and remote computerized device, and wherein the results of the at least two facial recognition program performances are compared for consistency.

10. A system according to claim 8 wherein results of the comparison are displayed using the user interface;

wherein the results include an indication of similarity between the image of the patient and the official photograph associated with the patient; and

wherein the facial recognition program indicates verification of the patient'"'"'s identity when the indication of similarity is above a threshold value.

11. A system according to claim 1 wherein the official photograph is a record photograph retrieved from at least one of a department of motor vehicles, a licensing agency, and a passport agency.

12. A system according to claim 1 wherein the official photograph on the photograph database is updated with an updated official photograph after a period of time;

wherein the first controller retrieves the updated official photograph from the photograph database; and

wherein the stored official photograph is replaced with the updated official photograph.

13. A system according to claim 12 wherein the updated official photograph is stored on the memory and defined as the stored official photograph;

and wherein the official photograph previously defined as the stored official photograph is retained within the memory.

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

wherein the backup event that activates the backup verification system is an indication from the first controller that the identity of the patient is not verified based on a comparison of the patient to the official photograph associated with the patient; and

wherein the action is at least one of calling a patient mobile telephone and speaking with the patient to verify the identity of the patient, providing a notification to the facility including a request that the patient contact the information collection center to verify the identity of the patient, and calling the facility and requiring the patient to verify the identity of the patient using a patient identifier.

15. A system according to claim 1 further comprising a biometric sensor in communication with the first controller.

16. A patient identity verification system based upon mutable biometric features comprising:

a first controller associated with a medical facility;

a memory associated with the first controller;

a second controller associated with a patient information collection center and adapted to be in communication with the first controller;

a network interface; and

a biometric scan database;

wherein the biometric scan database includes biometric scans that are verifiable as being associated with a patient, the biometric scans being defined as official biometric scans;

wherein the biometric scan database is accessible via the network interface;

wherein the first controller is configured to sends a signal to the second controller responsive to an occurrence of an event;

wherein the second controller is configured to initiates contact with the biometric scan database via the network interface in response to the signal received from the first controller;

wherein the first controller is configured to transmit a request for an official biometric scan associated with a patient to the second controller;

wherein an official biometric scan associated with the patient is identified within the biometric scan database;

wherein the second controller transmits the official biometric scan associated with the patient to the first controller in response to the signal received from the first controller so that the official biometric scan is viewable on a user interface at the medical facility;

wherein a copy of the official biometric scan is stored on the memory to define a stored biometric scan;

wherein the first controller is configured to facilitate verification that the stored official biometric scan remains an accurate depiction of the biometric feature of the patient associated therewith after a period of time during which the biometric feature of the patient associated with the stored biometric scan has changed by enabling the comparison of the stored biometric scan to the current official biometric scan of the same type of biometric feature as the biometric feature of the stored official biometric scan on the biometric scan database; and

wherein a patient identity is verified by performing a comparison of a biometric feature of the patient with the official biometric scan associated with the patient.

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

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

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

19. A system according to claim 16 wherein a medical software system in communication with the first controller is used by a medical professional at the medical facility;

wherein the medical professional is prompted to enter information relating to the patient using the medical software system; and

wherein the event is entry of the information relating to the patient using the medical software system.

20. A system according to claim 16, further comprising a billing system associated with the first controller, wherein the event is entry of information associated with the patient in the billing system.

21. A system according to claim 16 wherein the signal includes information relating to a claim for reimbursement relating to medical services being provided to the patient at the medical facility;

and 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 identity is verified.

22. A system according to claim 16 wherein a facial recognition program performs the comparison;

and wherein the facial recognition program performs the comparison at least one of the medical facility and the patient information collection center.

23. A system according to claim 16 wherein the official biometric scan is a photograph retrieved from at least one of department of motor vehicles, a licensing agency, a passport agency, and a law enforcement agency.

24. A system according to claim 16 wherein the official biometric scan on the biometric scan database is updated with an updated official biometric scan;

wherein the first controller is configured to retrieves the updated official biometric scan;

wherein the updated official biometric scan is stored on the memory and defined as the stored official biometric scan; and

wherein the official biometric scan previously defined as the stored official biometric scan is retained within the memory.

25. A system according to claim 16 further comprising a backup verification system that is activated to perform an action based on a backup event;

wherein the backup event that activates the backup verification system is an indication from the first controller that the patient identity is not verified based on the comparison of a biometric feature of the patient to the official biometric scan of the patient; and

wherein the action is at least one of calling the patient'"'"'s mobile telephone and speaking with the patient to verify the patient identity, providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient identity, and calling the medical facility and requiring the patient to verify the patient identity using a patient identifier.

26. A method of using a patient identity verification system that includes a first controller associated with a medical facility, a memory associated with the first controller;

a second controller associated with a patient information collection center and adapted to be in communication with the first controller, a network interface and a photograph database that is accessible via the network interface and includes photographs that are verifiable, the photographs being defined as official photographs, the method comprising;

sending a first signal from the first controller to the second controller responsive to an occurrence of an event;

initiating contact with the photograph database via the network interface in response to the first signal;

transmitting a request for an official photograph associated with a patient name;

identifying the official photograph associated with the patient name within the photograph database;

transmitting the official photograph associated with the patient name to the first controller so that the official photograph is viewable on a user interface at the medical facility;

storing a copy of the official photograph on the memory being defined as a stored official photograph;

verifying that the stored official photograph remains an accurate depiction of the patient associated therewith after a period of time during which the physical appearance of the patient associated with the stored official photograph has changed;

verifying a patient identity by performing a comparison of a patient with the official photograph associated with the patient; and

activating a backup verification system to perform an action based on a backup event;

wherein the backup event that activates the backup verification system is an indication from the first controller that the patient identity is not verified based on the comparison of the patient to the official photograph of the patient.

27. A method according to claim 26 wherein the event is reading patient information from a patient information unit that is associated with the patient.

28. A method according to claim 27 wherein the first controller is a patient information unit reader adapted to read the patient information associated with the patient information unit.

29. A method according to claim 26 wherein the event is one of entry of the information relating to the patient using a medical software system that is in communication with the first controller, and a billing system that is in communication with the first controller with respect to the patient.

30. A method according to claim 26 wherein the first signal includes information relating to a claim for reimbursement of expenses relating to medical services being provided to the patient at the medical facility.

31. A method according to claim 26 further comprising transmitting a second signal from the second controller to the first controller including an indication of whether or not the claim for reimbursement is a valid claim based on the indication of whether the patient identity is verified.

32. A method according to claim 26 wherein the step of verifying the patient identity is performed using a facial recognition program to perform the comparison.

33. A method according to claim 26 wherein the official photograph is a record photograph retrieved from at least one of a department of motor vehicles, a licensing agency, and a passport agency.

34. A method according to claim 26 wherein the action is at least one of calling the patient'"'"'s mobile telephone and speaking with the patient to verify the patient identity, providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient identity, and calling the medical facility and requiring the patient to verify the patient identity using a patient identifier.

35. A method according to claim 26 wherein the first controller is a biometric sensor;

and wherein the event is scanning a biometric feature using the biometric sensor.

36. A method according to claim 26 wherein the step of verifying that the stored official photograph remains an accurate depiction of the patient associated therewith comprises comparing the stored official photograph with the official photograph on the official photograph database.

37. A method of using a patient identity verification system that includes a first controller associated with a medical facility, a memory associated with the first controller, a second controller associated with a patient information collection center and adapted to be in communication with the first controller, a network interface and a photograph database that is accessible via the network interface and includes photographs that are verifiable, the photographs being defined as official photographs, the method comprising:

sending a first signal from the first controller to the second controller responsive to an occurrence of an event;

initiating contact with the photograph database via the network interface in response to the first signal;

transmitting a request for an official photograph associated with a patient name;

identifying the official photograph associated with the patient name within the photograph database;

transmitting the official photograph associated with the patient name to the first controller so that the official photograph is viewable on a user interface at the medical facility;

verifying a patient identity by performing a comparison of a patient with the official photograph associated with the patient;

storing a copy of the official photograph on a memory associated with the first controller to define a stored official photograph; and

determining if, after a period of time, the official photograph retrieved from the official photograph database has been replaced with an updated official photograph; and

upon a determination that the official photograph database has an updated official photograph, updating the stored official photograph with the updated official photograph to define an updated stored official photograph.

38. A method according to claim 37 wherein the event is reading patient information from a patient information unit that is assigned to the patient.

39. A method according to claim 37 further comprising prompting a medical professional to enter information relating to the patient using a medical software system in communication with the first controller;

wherein the event is entry of the information relating to the patient using the medical software system.

40. A method according to claim 37 wherein the event is use of a billing system in communication with the first controller with respect to the patient.

41. A method according to claim 37 wherein the first signal includes information relating to a claim for reimbursement of expenses relating to medical services being provided to the patient at the medical facility.

42. A method according to claim 37 further transmitting a second signal from the second controller to the first controller including an indication of whether or not the claim for reimbursement is a valid claim based on the indication of whether the patient identity is verified.

43. A method according to claim 37 wherein the step of verifying the patient identity is performed using a facial recognition program to perform the comparison.

44. A method according to claim 37 further comprising activating a backup verification system to perform an action based on a backup event;

wherein the backup event is an indication from the first controller that the patient identity is not verified based on the comparison of the patient to the official photograph of the patient;

wherein the action is at least one of calling the patient'"'"'s mobile telephone and speaking with the patient to verify the patient identity, providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient identity, and calling the medical facility and requiring the patient to verify the patient identity using a patient identifier.

45. A method according to claim 37 wherein the first controller is a biometric sensor;

and wherein the event is scanning a biometric feature using the biometric sensor.