MEDICAL DATA COLLECTION AND FRAUD PREDICTION SYSTEM AND METHOD

摘要

A goods, services and payment authorization system and method are provided 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, lack of insurance coverage and/or medical fraud, in general. 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.

主权项

1. A system for authorizing a user to receive at least one of healthcare related goods or services, comprising:
a computing device configured to make an authorization determination regarding the eligibility of the user for goods or services, a processor of said computing device configured by authorization and determination software to:
obtain at least one non-biometric identity information dataset of the user from a first source;assign a confidence level to the at least one identity information dataset;assign an importance multiplier to each data point of the at least one identity information dataset;score each data point using the confidence level of the dataset of which the data point is part and the importance multiplier assigned to the data point;add together the scores for each data point to obtain an overall score and comparing the overall score to a preset threshold; andif the overall score is greater than or equal to the preset threshold, report that the user is authorized to receive at least one of healthcare goods or services, otherwise, if the overall score is less than the preset threshold, report that the user is not authorized to receive the at least one of healthcare goods or services.