Patent ID: 6253186
Filing Date: 2001-06-26
Classification: G06Q

Abstract:
A computerized method for analyzing the billing patterns of a plurality of providers and suppliers of goods and services, and for identifying potentially fraudulent providers and suppliers, comprising the steps of:a. training a neural network to recognize patterns associated with fraudulent billing activity by providers and suppliers of goods and services;b. collecting data from said plurality of providers and suppliers, including claims data relating to claims submitted for payment by said providers and suppliers;c. extracting adjudicated line data from said claims data to construct a claim file;d. analyzing the line data in the claim file by means of the neural network to produce a numerical fraud indicator for at least one of said providers and suppliers;e. comparing the fraud indicator to a predetermined threshold indicator value;f. storing an identifier associated with each provider or supplier whose fraud indicator exceeds the predetermined threshold indicator value;g. analyzing data relating to each of the providers or suppliers whose identifiers were stored in step f, using an expert system inference engine in accordance with a plurality of expert system rules, to identify potentially fraudulent providers or suppliers; andh. producing a report which displays the identities of the potentially fraudulent providers or suppliers.