“Medical Data Collection and Fraud Prediction System and Method” in Patent Application Approval Process (USPTO 20160267484)

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- A patent application by the inventors SMOLEY, ROBERT (AVENTURA, FL); VOSS, ALLAN (BONITA SPRINGS, FL); JURKOV, ROMAN (DELRAY BEACH, FL); CARLSON, STEPHEN (FOLSOM, CA); TEZAK, TOMAS (BOCA RATON, FL), filed on May 26, 2016, was made available online on September 22, 2016, according to news reporting originating from Washington, D.C., by NewsRx correspondents (see also Patents).

This patent application has not been assigned to a company or institution.

The following quote was obtained by the news editors from the background information supplied by the inventors: "The invention relates to a medical data collection system and method and, more particularly, to a HIPAA compliant medical data collection system and method utilizing a determination method to verify the integrity of a user's identity and authorize goods and/or services.

"Healthcare fraud costs the health insurance/Medicare/Medicaid industry billions of dollars every year. Healthcare fraud can occur as the result of, on the Provider side, phantom billing, padded billing, double billing, upcoding, unbundling, and outright theft of Provider identities, among others. On the Patient side, healthcare fraud can take the form of prescription fraud, identity theft, forum shopping (Provider and pharmacy), and substance abuse/dealing. Such fraud can be hard to identify prior to the payout of a claim by the health insurance/Medicare/Medicaid industry.

"A number of references are known that have been directed to preventing healthcare fraud by authenticating that a user is who they say they are. For example, U.S. Pat. No. 7,421,399 to Kimmel discloses a system and method for implementing healthcare fraud countermeasures in which the patient provides a biometric signature to create a persistent record indicating that a particular person was physically present at a particular place. Similarly, U.S. Pat. No. 8,583,454 to Beraja et al., discloses a medical claims fraud prevention system in which a patient identity may be verified by performing a comparison of a patient with the official photograph of the patient. These references attempt to provide a patient authentication by validating that a user is who they say they are via a physical characteristic of the patient and/or by tying this physical characteristic to a data record or code.

"However, what is needed is an authorization system that validates that a user is entitled to a particular service or set of services via a determination process that verifies the integrity of the user's identity."

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventors' summary information for this patent application: "It is accordingly an object of the invention to provide a medical data collection system that validates that a user is entitled to a particular service or set of services via a determination process that verifies the integrity of the user's identity. In one particular embodiment of the invention, the system analyzes both real-time and historical data to assess the legitimacy of a healthcare transaction before allowing access, rendering services and/or processing payment.

"More particularly, in one embodiment of the invention the system operates as a goods, services and payment authorization system, to prevent services from being rendered, goods from being provided and/or reimbursements from being made in the case of fraudulent healthcare transactions resulting from identity theft, phantom billing, medical fraud and lack of insurance coverage, in general. More particularly, in one particular embodiment of the invention, in conjunction with a healthcare transaction, patient identity information is collected and insurance coverage is confirmed using a programmatic calculation of a confidence determination based on the collected identity information.

"Although the invention is illustrated and described herein as a medical data collection and fraud prediction system and method, it is nevertheless not intended to be limited to the details shown, since various modifications and structural changes may be made therein without departing from the spirit of the invention and within the scope and range of equivalents of the claims.

"The construction and method of operation of the invention, however, together with additional objects and advantages thereof will be best understood from the following description of specific embodiments when read in connection with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

"For the purpose of illustrating the invention, there is shown in the drawings an exemplary embodiment that is presently preferred, it being understood however, that the invention is not limited to the specific methods and instrumentalities disclosed. Additionally, like reference numerals represent like items throughout the drawings. In the drawings:

"FIG. 1 is an exemplary diagram illustrating one particular embodiment of the invention;

"FIG. 2 is a simplified block diagram of a portion of the system in accordance with one particular embodiment of the invention;

"FIGS. 3A and 3B are an exemplary illustration of the front and back, respectively, of an official government-issued ID card, useful in a process in accordance with one particular embodiment of the invention;

"FIG. 4 is a flow chart illustrating the scoring and determination processes performed in accordance with one particular embodiment of the invention;

"FIG. 5 is a flow chart illustrating method of performing a data point scoring process in accordance with one particular embodiment of the present invention;

"FIG. 6 is an exemplary table illustrating a confidence level determination for a particular dataset in accordance with one embodiment of the present invention;

"FIG. 7 is an exemplary table illustrating a confidence level determination for particular data points in accordance with one embodiment of the present invention;

"FIG. 8 is an exemplary table illustrating an importance multiplier determination for particular data points in accordance with one embodiment of the present invention;

"FIG. 9 is an exemplary authorization process used to illustrate one particular embodiment of the present invention; and

"FIG. 10 is an exemplary authorization process used to illustrate a particular embodiment of the present invention."

URL and more information on this patent application, see: SMOLEY, ROBERT; VOSS, ALLAN; JURKOV, ROMAN; CARLSON, STEPHEN; TEZAK, TOMAS. Medical Data Collection and Fraud Prediction System and Method. Filed May 26, 2016 and posted September 22, 2016. Patent URL: http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=2801&p=57&f=G&l=50&d=PG01&S1=20160915.PD.&OS=PD/20160915&RS=PD/20160915

Keywords for this news article include: Patents, Medicaid, Medicare, Legal Issues, Health Policy, Health Insurance.

Our reports deliver fact-based news of research and discoveries from around the world. Copyright 2016, NewsRx LLC