Healthcare insurance claim fraud detection using datasets derived from multiple insurers

US8214232B2 · kind B2 · utility

Assignee

• Fair Isaac Corporation · US

Inventors

• Michael Tyler · San Diego, US
• Nitan Basant · Bengaluru, IN
• Robin P · Bengaluru, IN
• Shafi Ur Rahman · San Diego, US

Key dates

• Filing date: Apr 22, 2010
• Grant date: Jul 3, 2012
• Expiry date: Dec 9, 2030

Classification

• Technology area (CPC G): Physics
• CPC primary: G06Q40/08
• WIPO field: IT methods for management
• WIPO sector: Electrical engineering

Abstract

Various techniques are described that enable a smaller insurer (or an insurer with a less developed dataset) to be able to characterize whether certain healthcare insurance claim elements are potentially fraudulent or erroneous. Datasets from larger insurers (with well developed datasets) and/or datasets from a consortium of insurers can be leverage by the smaller insurer. Related techniques, apparatus, systems, and articles are also described.