Patent ID: 8229770

Claim:
A method of controlling healthcare claim payment losses, the method comprising: receiving a healthcare claim for services rendered to a patient by a provider, wherein a payer has screened the healthcare claim to confirm eligibility and compensability, and wherein the payer has further determined that any related deductibles have been satisfied such that the payer is prepared to pay the healthcare claim, but prior to payment of the healthcare claim; and evaluating information about the healthcare claim for potential fraudulent activity wherein evaluating the information for potential fraudulent activity comprises: determining with one or more computer processors whether the services set forth in the healthcare claim are for single service billings based on accessing a frequency history of past services rendered to the patient to determine whether the single service billings have occurred multiple times; and determining with one or more computer processors whether the services provided to the patient as set forth in the healthcare claim are appropriate for the age of the patient.