System and method for implementing healthcare fraud countermeasures

• US 7,421,399 B2
• Filed: 03/19/2007
• Issued: 09/02/2008
• Est. Priority Date: 01/22/2003
• Status: Expired due to Fees

• Current Assignee: Scott T. Kimmel
• Original Assignee: Scott T. Kimmel
• Inventors: Kimmel, Scott T.
• Primary Examiner(s): Gilligan; C. Luke
• Assistant Examiner(s): RINES, ROBERT D
• Application Number:
  US11/688,212
• Publication Number:
  US 20070168232A1
• Time in Patent Office: 533 Days
• Field of Search: 705/2, 705/3, 705/4, 435/5
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• 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 method of discouraging healthcare fraud in conjunction with providing a health care service to a patient in which the patient provides a biometric signature. An event record is created where the event record creates an association between the biometric signature, a patient identifier, and location information indicating a location at which the biometric signature is obtained. The event record is stored in a central data store and can be later retrieved to verify the patient was present at the location.

Claims

1. A method of discouraging healthcare fraud comprising:

causing a patient to provide a biometric signature on a date and at a location where the health care service is provided;

capturing said biometric signature;

creating a record that records said patient was at said location at a particular time and/or date, said record comprising a patient identifier, said biometric signature, location information indicating said particular location at which said biometric signature is obtained;

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.

2. The method of claim 1 wherein said act of storing said record is performed before said biometric signature is used to identify said patient receiving said healthcare services.

3. The method of claim 1 wherein said act of storing said record is performed before said biometric signature is used to authenticate said person receiving said healthcare service.

4. The method of claim 1 wherein said healthcare service comprises a service that is reimbursable by a private insurance plan and/or a public program.

5. The method of claim 1 further comprising obtaining a biometric signature at least two times during said provision of health care services.

6. The method of claim 1 further comprising:

receiving a claim for reimbursement for said health care services;

retrieving one or more records corresponding to said health care services from said data store;

matching said claim for reimbursement to a record for a particular patient to determine whether said one or more records indicate that said patient was at a suitable location for providing said health care services; and

authorizing financial reimbursement of said health care service based in part upon said determination that said patient was present at a location suitable for providing said health care service.

7. The method of claim 1 further comprising:

retrieving one or more records from said data store; and

performing a fraud detection process using said retrieved records.

8. The method of claim 1 wherein said biometric signature comprises a fingerprint scan record.

9. The method of claim 1 further comprising:

including within said record an indication of consumable materials used during provision of said healthcare services.

10. The method of claim 1 further comprising:

including within said record and indication of equipment used during provision of said healthcare services.

11. The method of claim 1 further comprising:

including within said record an indication of procedures performed during said provision of said healthcare services.

12. The method of claim 1 wherein said location information comprises an identification code assigned to a health care provider and/or heath care facility.

13. The method of claim 1 wherein said location information comprises a geocode.

14. The method of claim 1 wherein said location information comprises a network address of a computer used to obtain said biometric signature.

15. The method of claim 1 wherein said location information comprises a device address of a fingerprint scanner.