Fraud lead detection system for efficiently processing database-stored data and automatically generating natural language explanatory information of system results for display in interactive user interfaces
US10628834B1 · kind B1 · utility
Assignee
Inventors
Key dates
| Filing date | Jun 14, 2016 |
| Grant date | Apr 21, 2020 |
| Priority date | — |
| Expiry date | Aug 2, 2036 |
Classification
- Technology area (CPC G)Physics
- CPC primaryG06N7/01
- WIPO fieldComputer technology
- WIPO sectorElectrical engineering
Abstract
Systems and methods are described for automatically processing data stored in one or more databases using machine learning to detect entities (such as health care providers, health care plan members, patients, pharmacies, and so forth) associated with health care claims that are suspected of fraudulent, wasteful, and/or abusive activity. The techniques may further or alternatively involve generating and presenting, for a set of suspected entities, natural language explanatory information explaining how and/or why each of the respective suspected entities is considered to be suspected of fraudulent, wasteful, and/or abusive activity. Feedback provided by fraud analysts and/or other subject matter experts in the misuse detection space is used to facilitate misuse detection and misuse detection presentation.
Source: USPTO / EPO open patent data. Objective bibliographic and citation counts.