Source: https://patents.google.com/patent/US8392211B2/en
Timestamp: 2020-02-18 06:44:42
Document Index: 164846983

Matched Legal Cases: ['Application No. 2007', 'art 40', 'art 40', 'art 60', 'art 115', 'art 160', 'art 160', 'art 340', 'art 340', 'art 400']

US8392211B2 - Medical claims fraud prevention system including patient call initiating feature and associated methods - Google Patents
Medical claims fraud prevention system including patient call initiating feature and associated methods Download PDF
US8392211B2
US8392211B2 US12/832,427 US83242710A US8392211B2 US 8392211 B2 US8392211 B2 US 8392211B2 US 83242710 A US83242710 A US 83242710A US 8392211 B2 US8392211 B2 US 8392211B2
US12/832,427
US20100332252A1 (en
2010-07-08 Priority to US12/832,427 priority patent/US8392211B2/en
2010-12-30 Publication of US20100332252A1 publication Critical patent/US20100332252A1/en
2013-03-05 Publication of US8392211B2 publication Critical patent/US8392211B2/en
2013-08-07 Assigned to BERAJA, ESTHER, MATILDE BERAJA REVOCABLE TRUST, BERAJA, VICTOR, ISIDORO BERAJA IRREVOCABLE TRUST, BERAJA, ROBERTO reassignment BERAJA, ESTHER ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: IBEZA LLC
A medical claim fraud prevention system includes a first controller positioned at a medical facility and a second controller positioned at a patient information collection center and adapted to be in communication with the first controller. The first controller may transmit a first signal to the second controller responsive to an occurrence of a predetermined event. The second controller may initiate contact with a patient via the patient's mobile phone in response to the first signal received from the first controller, and the patient may be prompted to enter predetermined information to verify their location. The second controller may transmit an indication to the first controller in response to the first signal received from the first controller regarding whether the patient is within a predetermined vicinity of the medical facility based on the predetermined information entered by the patient to verify their location.
This application is a continuation in part of U.S. patent application Ser. No. 12/614,841 titled Medical Decision System Including Question Mapping and Cross Referencing System and Associated Methods filed on Nov. 9, 2009, which is a continuation-in-part of U.S. patent application Ser. No. 11/928,690 filed on Oct. 30, 2007 and titled Medical Decision Auditing Method and System, which, in turn, was a divisional application of U.S. patent application Ser. No. 11/191,304, now U.S. Pat. No. 7,464,042 filed on Jul. 28, 2005 and titled Medical Professional Monitoring System and Associated Methods, the entire contents of each of which are incorporated herein by reference. The present application is also related to U.S. patent application Ser. No. 12/614,910 titled Medical Decision System Including Interactive Protocols and Associated Methods filed on Nov. 9, 2009, and U.S. patent application Ser. No. 12/614,937 titled Medical Decision System including Medical Observation Locking and Associated Methods filed on Nov. 9, 2009, the entire contents of each of which are incorporated herein by reference. The present application is also related to U.S. patent application Ser. No. 12/832,354 titled Medical Claims Fraud Prevention System And Associated Methods by the inventors of the present application, U.S. patent application Ser. No. 12/832,500 titled Medical Claims Fraud Prevention System Including Historical Patient Locating Feature And Associated Methods by the inventors of the present application, and U.S. patent application Ser. No. 12/832,458 titled Medical Claims Fraud Prevention System Including Patient Identification Interface Feature And Associated Methods by the inventors of the present application, each filed simultaneously herewith, the contents of each of which are incorporated herein by reference.
In their never ending pursuit to enhance their profitability, insurance companies force medical professionals and medical supply companies to accept decreased payments. These are sometimes referred to as “negotiated” rates. These negotiated rates can amount to a much lower amount than a medical professional or medical supply company had planned on charging for their services or products. As time goes on, the negotiated rates tend to have an adverse affect on profitability. One effect of the decreased profitability is that some medical professionals and medical supply companies are forced to go out of business. Another effect, unfortunately, can be that in order to make up for the lost profits, some medical professionals and medical supply companies engage in fraudulent behaviors. These fraudulent behaviors may, for example, include submitting requests for reimbursements for medical expenses to insurance companies for medical services that were not rendered to a patient or for medical products that were not supplied to a patient. Fraudulent acts such as this have, in the past, seen considered victimless crimes, i.e., the only one getting hurt is the insurance company. Accordingly, not much attention has been paid to this issue until it has become apparent that the fraudulent behavior may be a source of rising healthcare costs.
Current systems that are used to monitor medical services that are provided to patients are outdated and can be costly. For example, some insurance companies transmit a notice to a patient after a medical service has been provided. The notice indicates that medical service that has been provided and the portion of the service that covered by the insurance company. This type of system carries out fraud prevention by putting the patient on notice of the type of service that a medical professional may be seeking reimbursement for. If the service did not occur, then a patient receiving the notification will likely contact the insurance company to clear up the discrepancy.
U.S. Published Patent Application No. 2007/0299776 by Frustaci et al. discloses a method for preventing medical fraud that uses a real time transmitted identification system to verify patient identification, location, time and medical service provider identification. The system verifies provision of services to an authorized service user by assigning a unique identifying number to each authorized service provider and by assigning a unique identifying number to each authorized service user. The system determines the likelihood that an insurance claim by a service provider is valid by defining the unique identifying feature of each of the authorized patients and for each of the authorized doctors. Accordingly, the system is directed to determining probabilities of whether or not a medical claim may be fraudulent. The Frustaci et al. '776 patent application discloses that the patient's physical location may be determined by an attached GPS system at the provided location. The system obtains the patient's and the providers fingerprints, or other identifying feature, and transmits the identifying feature information to a service confirmation center in real time.
These and other objects, features and advantages according to the present invention are provided by a medical claim fraud prevention system comprising a first controller positioned at a medical facility and a second controller positioned at a patient information collection center. The second controller is adapted to be in communication with the first controller.
FIGS. 20-22 are flowcharts illustrating methods of preventing a medical claim fraud according to an alternate embodiment of the invention.
The system 10 may also include a second controller 14 positioned at a patient information collection center 20. The second controller 14 may be adapted to be in communication with the first controller 12. More specifically, the first and second controllers 12, 14 may be in communication with one another in any number of ways. After having had the benefit of reading this disclosure, those skilled in the art will appreciate that the first and second controllers 12, 14 may be positioned in communication with one another via a wireless connection, a modem, a radio link, a LAN, or any other types of connection suitable for allowing the first and second controllers 12, 14 to communicate with one another and to transmit data, in any form, and other information between one another. More particularly, the system 10 according to an embodiment of the present invention contemplates that data in the form of text, pictures, video or any other form may be transmitted between the first and second controllers 12, 14 to carry out the objects, features and advantages according to the present invention.
As indicated above, the patient locating device 16 may, for example, be a patient's cell phone (also referred to herein as a mobile telephone, and to be understood to refer to any portable telephonic device). The patient locating device 18 may also be provided by any other type of signal emitting device that is adapted to be within a vicinity of the patient and, more particularly, adapted to be routinely carried by the patient. Other examples of the patient locating device 16 may include a key fob to be connected to a key ring, or even a small card including a transmitting device, e.g., a radio frequency transmitter, that can be readily carried within the wallet of a patient. A card version of the patient locating device 16 may advantageously be integrated with an insurance card carried by the patient so that the patient routinely has the patient locating device on their person when at a medical facility.
The patient locating device 16 may, for example, be a device that is enabled with a global positioning system, i.e., a GPS enable device. Those skilled in the art will appreciate, after having had the benefit of reading this disclosure, that most modern cell phones are GPS enabled, but the system 10 according to the present invention provides for use of other GPS enabled devices such as, for example, a GPS enabled personal digital assistant, a GPS enabled pager, a GPS enabled handheld device associated with providing medical care or any other GPS enabled device that may be carried within a general vicinity of a patient. General vicinity, for purposes of the system 10 according to the present invention, is meant to indicate a vicinity within which a patient is located, i.e., on the person of the patient or within a close distance to the patient, i.e., in a patient's purse, bag, backpack, within the patient's vehicle, etc.
The first controller 12 may send a first signal to the second controller 14 responsive to an occurrence of a predetermined event. In turn, the second controller 14 may transmit an indication to the first controller 12 in response to the first signal received from the first controller of whether the patent locating device 16 is within a predetermined vicinity of the medical facility 18. This indication may be based on the location data relating to the location of the patient locating device 16. Accordingly, the system 10 according to the present invention advantageously provides an indication of a location of the patient locating device 16 with respect to the medical facility 18 upon the occurrence of the predetermined event so that it may be determined whether or not the patient locating device is within the vicinity of the medical facility when, for example, medical services are rendered to the patient. Again, the present invention makes the assumption that the patient locating device 16 is a device that is within a general vicinity of the patient that is receiving the medical services or any other type of medical treatment, i.e., therapy, counseling, etc. at the medical facility 18. This embodiment of the system 10 according to the present invention assumes that the medical services are being rendered at the time that the predetermined event occurs which prompts a determination of the location of the patient locating device 16 with respect to the medical facility 18, or within a close proximity to the time that the predetermined event occurs.
In one embodiment of the system 10 according to the present invention, the patient may be assigned a patient information unit 22 having predetermined patient information associated therewith. The patient information unit 22 may, for example, be a patients insurance card. The patient insurance card may include a transmitting device embedded therein. For example, the patient insurance card may include a radio frequency transmitter embedded within a body portion thereof. The predetermined event that may trigger the action of determining the location of the patient locating device 16 may, for example, be reading information from the patient information unit 22. For example, when a patient presents the patient insurance card to a medical professional upon entering the medical facility 18 to receive medical services, or other types of medical treatment, the medical professional may read information from the patient insurance card using a device adapted to read patient information from the patient insurance card. Upon the occurrence of such event, the first controller 12 may send first signal to the second controller 14 to determine a location of the patient locating device 16 with respect to the medical facility 18.
This configuration of the system 10 according to the present invention is advantageous when a medical facility is not equipped with a patient information unit reader 24 that may read information from a patient information unit 22. In this configuration, the medical professional may manually enter information relating to the patient into the software system 26. Upon entering information relating to the patient into the medical software system 26, the first controller 12 may send the first signal to the second controller 14 to prompt retrieval of location data relating to the patient locating device 16. After having had the benefit of reading this disclosure, those having skill in the art will appreciate that any use of a medical software system 26 may be the predetermined event that prompts retrieval of location date of the patient locating device 16.
The signal transmitted from the first controller 12 to the second controller 14 may include information restating to a claim for reimbursement of medical services being provided to the patient at the medical facility 18. More specifically, the signal transmitted from the first controller 12 to the second controller 14 may include a request for reimbursement of the medical treatment, or other medical services being provided to the patient at the medical facility 18 so that more immediate or more rapid payment of the medical services being provided to the patient are provided to the medical professional. This advantageously enhances efficiency of the provision of medical services and payments for same, as well as enhances collection efforts of medical professionals when dealing with health insurance companies, for example. The second controller 14 may transmit a signal to the first controller including an indication of whether or not the claim is a valid claim based on the indication of whether or not the patient locating device 16 is within the predetermined vicinity of the medical facility 18.
Those skilled in the art will appreciate, after having had the benefit of reading this disclosure, that the system 10 according to the present invention may advantageously use biometric sensors to satisfy a number of features. For example, a biometric sensor may be positioned at the medical facility 18 to read a biometric feature of a patient, i.e., a thumb print, a finger print, an eye scan, etc., of a patient. This cart advantageously be used to verify the identity of the patient that presents at the medical facility 18. This can also be used to prompt a determination of the location of the patient locating device 16 with respect to the medical facility. For example, the biometric sensor may be positioned in communication with the first controller 12, thereby prompting the first controller to send the first signal to determine the location of the patient locating device with respect to the medical facility at the time that the biometric sensor senses a biometric feature of the patient. Alternately, the biometric sensor may be integrally formed into the first controller 12. Either arrangement provides the advantage of automatically determining a location of the patient locating device 16 upon determining the identity of the patient at the medical facility.
Referring now additionally to the flowchart 40 illustrated in FIG. 2, a method aspect of the present invention is now described in greater detail. The method according to the present invention, and as illustrated in the flowchart 40 of FIG. 2, is directed to preventing medical claim fraud by determining the location of a patient locating device and by ensuring that the patient locating device is within a predetermined vicinity of the medical facility where medical services are being provided. From the start (Block 42), it is determined at Block 44 whether the predetermined event has occurred. If it is determined at Block 44 that the predetermined event has not occurred, then the system reverts back to the start Block 42 to await occurrence of the predetermined event. If it is determined at Block 44, however, that the predetermined event has occurred, a first signal is transmitted from the first controller to the second controller at Block 46.
At Block 68, it is determined if the patient locating device is within the predetermined vicinity of the medical facility at the time that the patient information unit reader is used to read predetermined patient information from the patient information unit (wherein reading predetermined patient information from the patient information unit using a patient information unit reader is an indication that the medical services are being provided to the patient). If is determined at Block 68 that the patient locating device is within the predetermined vicinity of the medical facility at the time the medical services are being provided to the patient, then an indication is transmitted back to the first controller that the patient locating device is within the predetermined vicinity at Block 70. If, however, it is determined at Block 68 that the patient locating device is not within the predetermined vicinity of the medical facility at the time the patient information unit reader is used to read the predetermined patient information from the patient information unit, then an indication is transmitted that the patient locating device is not within the predetermined vicinity of the medical facility at Block 72. Accordingly, the predetermined event that prompts a determination of the location of the patient locating device with respect to the medical facility in the method aspect of the invention illustrated in the flowchart 60 of FIG. 3 is reading predetermined patient information from the patient information unit using the patient information unit reader. The method is ended at Block 74.
At Block 88, it is determined if the patient locating device is within the predetermined vicinity of the medical facility at the time that the medical professional enters information relating to the patient using the medical software system (wherein use of the medical software system with respect to the patient is an indication that the medical services are being provided to the patient). If it is determined at Block 88 that the patient locating device is within the predetermined vicinity of the medical facility at the time the medical professional uses the medical software system to enter information relating to the patient, then an indication is transmitted that the patient locating device is within the predetermined vicinity of the medical facility at Block 90. If, however it is determined at Block 88 that the patient locating device is not within the predetermined vicinity of the medical facility at the time the medical software system is being used by the medical professional to enter information relating to the patient, then an indication is transmitted that the patient locating device is not within the predetermined vicinity of the medical facility at Block 92. Accordingly, in this method aspect of the invention, the predetermined event that prompts the first signal to be transmitted from the first controller to the second controller to determine the location of the patient locating device with respect to the medical facility is use of the medical software system with respect to the patient. The method is ended at Block 94.
Referring now additionally to the flowchart 115 illustrated at FIG. 6, yet another method aspect according to an embodiment of the present invention is now described in greater detail. More specifically, the method illustrated in FIG. 6 is directed to a method of preventing medical claim fraud by locating a patient locating device to ensure that the patient locating device is within a predetermined vicinity of the medical facility at the time the medical services are being provided to the patient that includes transmitting a claim for reimbursement to a medical insurance company at the same time that the location of the patient locating device is determined. From the start (Block 116), it is determined at Block 118 whether or not the predetermined event has occurred. If it is determined at Block 118 that the predetermined event has not occurred, then the method reverts back to the start at Block 116. If, however, it is determined that the predetermined event has occurred at Bock 118, then a first signal is transmitted from the first controller to the second controller at Block 120. The signal may include information relating to a claim for reimbursement for medical services being provided to the patient, along with a request to determine the location of the patient locating device.
At Block 124, it is determined if the patient locating device is within the predetermined vicinity of the medical facility at the time that the predetermined event has occurred (wherein occurrence of the predetermined event is an indication that the medical services are being provided to the patient), if it is determined at Block 124 that the patient locating device is within the predetermined vicinity of the medical facility at the time the medical services are being provided to the patient, then an indication is transmitted from the second controller to the first controller that the patient locating device is within the predetermined vicinity at Block 126.
Referring now additionally to the flowchart 160 illustrated in FIG. 8, yet another method aspect of the present invention is now described in greater detail. The method aspect of the invention illustrated in the flowchart 160 of FIG. 8 provides greater detail as to use of the backup locating system. More specifically, from the start (Block 162), it is determined at Block 164 whether or not an indication has been transmitted from the second controller to the first controller that the patient locating device is not within the predetermined vicinity of the medical facility at the time the medical services are being provided to the patient. If it is determined at Bock 164 that the patient locating device is not within the predetermined vicinity of the medical facility at the time the medical services are being provided to the patient, then the method is ended at Block 170. If, however, it is determined at Block 164 that the patient locating device is within the predetermined vicinity of the medical facility at the time the medical services are being provided to the patient, then the backup locating system is activated at Block 166. At Block 168, the medical facility is called and the patient is required to verify their location using a predetermined patient identifier, as described in greater detail above. Thereafter, the method is ended at Block 170.
As also noted above, the predetermined information that the patient is prompted to enter responsive to the telephone call to the patients mobile telephone may, for example, be a personal identification number. The patient may enter the personal identification number using the telephone keypad. Of course, those skilled in art will appreciate that the personal identification number may be related to numerals on the telephone keypad, or may be related to letters associated with the numerals on the telephone keypad. The predetermined information that the patient is prompted to enter may also be a verbal response to a question presented to the patient. This verbal response may include the personal identification number, or some other unique identifier that may either be predetermined, or that the patient may set. Accordingly, the system 10 according to an embodiment of the present invention contemplates the use of a voice recognition system to recognize a verbal response being made by the patient in response to the presented question.
The system 10 according to the present invention contemplates that an automated system may be used to prompt the patient to enter the predetermined information, i.e. a pre-recorded system adapted to recognize entry of the information from the patient and process that information using a processor to determine whether or not the patient is located within the predetermined vicinity of the medical facility 18. Alternately, a customer service representative, i.e., a live person, may initiate this telephone call, and actually speak to the patient to determine whether or not the patient is within the predetermined vicinity of the medical facility 18 at the time that medical services are being provided to the patient. If the customer service representative determines that the patient is within the predetermined vicinity of the medical facility during the time that the medical services are being provided, then the customer service representative may cause the second controller to transmit an indication to the first controller that the patient is within the predetermined vicinity of the medical facility at the time that the medical services are being provided.
Thereafter, the second controller 14 may request identification information from the patient in response to the first signal received from the first controller 12. As illustrated in the schematic box 491, the patient may enter the identification information using the user interface 28 in communication with the second controller 14 to verify the patient's location. The second controller 14 may transmit an indication to the first controller 12 in response to the first signal received from the first controller regarding whether the patient is within the predetermined vicinity of the medical facility 18 based on the identification information entered by the patient using the user interface 28 to verify their location. In other words, if the patient has not entered the necessary identification information into the user interface 28, or if the patient has entered incorrect identification information into the user interface, then the second controller 14 may transmit a signal to the first controller 12 that the patient is not within the predetermined vicinity of the medical facility 18. If, however the patient has entered the proper identification information into the user interface 28, then an indication may be transmitted from the second controller 14 to the first controller 12 that the patient is within the predetermined vicinity of the medical facility 18.
Similar to the embodiment of the medical claim fraud prevention system 10 described above, the identification information to be entered by the patient may be a personal identification number. The personal identification number may be a series of numerals, words, letters, or any combination thereof that may be entered using the user interface 28 located at the medical facility 18. Also similar to alternate embodiments of the medical claim fraud prevention system 10 according to the present invention, the patient information collection center 20 may be associated with processing health insurance claims, and the signal transmitted from the first controller 12 to the second controller 14 may include information relating to a claim for reimbursement relating to medical services being provided to the patient at the medical facility 18. The second controller 14 may transmit a signal to the first controller 12 including an indication as to whether or not the claim is a valid claim based on the indication of whether the patient is within the predetermined vicinity of the medical facility 18 at the time that the medical services are being provided.
Referring now additionally to the flowchart 340 illustrated in FIG. 22, still another method aspect according to an embodiment of the present invention is now described in greater detail. The method illustrated in the flowchart 340 illustrated in FIG. 22 provides for the ability to transmit a request for reimbursement for the provision of the medical services when transmitting the first signal from the first controller to second controller, and also provides for transmitting an indication back to the first controller that a claim is valid or invalid based on the determination of the location of the patient at the time that the medical services are being provided.
Referring now additionally to the flowchart 400 illustrated in FIG. 26, another method aspect of an embodiment of the present invention is now described in greater detail. More specifically, from the start (Block 402), it is determined at Block 404 whether or not the predetermined event has occurred. If it is determined at Block 404 that the predetermined event has not occurred, then the method awaits occurrence of the predetermined event at the start Block 402. If, however, it is determined at Block 404 that the predetermined event has occurred, then a first signal is transmitted from the first controller to the second controller at Block 406, and historical location data of the patient locating device is retrieved from a data center at Block 408. The first signal may also include information relating to a request for reimbursement of medial expenses for medical services that were provided to the patient.
At Block 410, it is determined whether or not the historical location data retrieved from the data center indicates that the patient locating device was within the predetermined vicinity of the medical facility during the predetermined time period (wherein the predetermined time period is presumably an indication of the time period during which medical services were provided to the patient). If it determined at Block 410 that the patient locating device was within the predetermined vicinity of the medical facility during the predetermined time period, then an indication is transmitted from the second controller to the first controller that the patient locating device was within the predetermined vicinity during the predetermined time period at Block 412. Along with this indication, the signal may include an indication that the claim is a valid claim based on the location of the patient locating device during the predetermined time period at Block 414. If, however, it is determined at Block 410 that the historical location data does not indicate that the patient locating device was not within the predetermined vicinity of the medical facility during the predetermined time period, than an indication is transmitted from the second controller to the first controller that the patient locating device was not within the predetermined vicinity during the predetermined time period at Block 416. Thereafter, the method is ended at Block 418.
a second controller positioned at a patient information collection center and adapted to be in communication with the first controller; and—
wherein the medical software system sends the medical information related to the patient to the first controller;
wherein the first controller sends a signal requesting the location of the patient to the second controller responsive to the information received from the medical software system;
wherein the second controller initiates contact with the patient via a mobile telephone of the patient in response to the signal received from the first controller;
wherein the patient is prompted to enter information into the patient's mobile telephone;
wherein the second controller receives information from the patient's mobile telephone, the information providing an indication of the patient's location; and
wherein the second controller determines information received from the patient's mobile telephone properly identifies the patient and indicates the patient's location being within a vicinity of the medical facility; and
wherein the second controller transmits an indication to the first controller in response to the first signal received from the first controller regarding whether the patient is within a vicinity of the medical facility based on the determination as to whether the information received from the patient's mobile telephone properly identifies the patient and indicates the patient's location being within a vicinity of the medical facility.
3. A system according to claim 1 wherein the medical facility is at least one of a doctor's office, a hospital, a pharmacy, a therapy center, a medical laboratory, a medical clinic, a rehabilitation facility, a dialysis unit, an outpatient center, an assisted care living facility, an emergency room and a nursing home.
4. A system according to claim 1 wherein the patient information collection center is associated with processing health insurance claims.
5. A system according to claim 1 wherein the signal transmitted from the first controller to the second controller includes information relating to a claim for reimbursement relating to medical services being provided to the patient at the medical facility.
6. A system according to claim 5 wherein the second controller transmits a signal to the first controller including an indication of whether or not the claim is a valid claim based on the indication of whether the patient is within the vicinity of the medical facility.
7. A system according to claim 1 wherein the information that the patient is prompted to enter is a personal identification number.
8. A system according to claim 1 wherein the information that the patient is prompted to enter is pressing a number on the telephone in response to a question presented to the patient.
9. A system according to claim 1 wherein the information that the patient is prompted to enter is a verbal response to a question presented to the patient.
11. A system according to claim 10 wherein the backup event that activates the backup locating system is an indication from the second controller that the patient is not within the vicinity of the medical facility based on the information entered by the patient to verify their location.
12. A system according to claim 10 wherein the action is at least one of calling the patient's mobile telephone and speaking with the patient to determine the location of the patient, and providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient's location.
13. A system according to claim 10 wherein the action is calling the medical facility and requiring the patient to verify their location using a patient identifier.
transmitting the patient information received by the medical software system to a first controller positioned at a medical facility that includes a user interface;
transmitting a signal from the first controller to a second controller positioned at a patient information collection center responsive to the patient information received by the first controller from the medical software system, wherein the second controller is adapted to be in communication with the first controller;
initiating a telephone call to a mobile telephone of the patient;
prompting a patient to enter information into the mobile telephone, wherein the information provides an indication an indication of the patient's location; and
transmitting an indication from the second controller to the first controller in response to the first signal received from the first controller of whether the patient is within a vicinity of the medical facility based on a determination as to whether the information received from the patient's mobile telephone properly identifies the patient and indicates the patient's location being within a vicinity of the medical facility.
16. A method according to claim 15 wherein the medical software system is at least one of a billing system and a patient information collection system.
17. A method according to claim 15 wherein the medical facility is at least one of a doctor's office, a hospital, a pharmacy, a therapy center, a medical laboratory, a medical clinic, a rehabilitation facility, a dialysis unit, an outpatient center, an assisted care living facility, an emergency room and a nursing home.
18. A method according to claim 15 wherein the patient information collection center is associated with processing health insurance claims.
19. A method according to claim 15 wherein the signal transmitted from the first controller to the second controller includes information relating to a claim for reimbursement relating to medical services being provided to the patient at the medical facility.
20. A method according to claim 19 further comprising transmitting a signal from the second controller transmits to the first controller including an indication of whether or not the claim is a valid claim based on the indication of whether the patient is within the vicinity of the medical facility.
21. A method according to claim 15 wherein the information that the patient is prompted to enter is a personal identification number.
22. A method according to claim 15 wherein the information that the patient is prompted to enter is pressing a number on the telephone in response to a question presented to the patient.
23. A method according to claim 15 wherein the information that the patient is prompted to enter is a verbal response to a question presented to the patient.
25. A method according to claim 24 wherein the backup event that activates the backup locating system is an indication received from the second controller that the patient is not within the vicinity of the medical facility.
26. A method according to claim 24 wherein the action is at least one of calling the patient's mobile telephone and speaking with the patient to determine the location of the patient, and providing a notification to the medical facility including a request that the patient contact the patient information collection center to verify the patient's location.
27. A method according to claim 24 wherein the action is calling the medical facility and requiring the patient to verify their location using a patient identifier.
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US12/832,427 US8392211B2 (en) 2005-07-28 2010-07-08 Medical claims fraud prevention system including patient call initiating feature and associated methods
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US20100332252A1 (en) 2010-12-30