Detection of upcoding and code gaming fraud and abuse in prospective payment healthcare systems
US8666757B2 · kind B2 · utility
Assignee
Inventors
Key dates
| Filing date | Nov 15, 2002 |
| Grant date | Mar 4, 2014 |
| Priority date | — |
| Expiry date | Feb 23, 2028 |
Classification
- Technology area (CPC G)Physics
- CPC primaryG06Q40/00
- WIPO fieldIT methods for management
- WIPO sectorElectrical engineering
Abstract
Fraud and abuse detection in an entity's payment coding practices includes the ability to search for fraud at all levels of the hierarchical coded payment system within the context of an unsupervised model. The model uses variables derived and profiles created at any level or at all levels of the hierarchical coded payment system to create a comprehensive description of the payment coding activities submitted by the entity. That description is compared with other peer entities to determine unusual and potentially inappropriate activity. The profiles created may themselves be utilized for purposes other than the detection of fraud and abuse.
Source: USPTO / EPO open patent data. Objective bibliographic and citation counts.