Patent ID: 8688607

Claim:
A method for detecting healthcare insurance fraud, the method comprising: creating a data base containing source data related to at least one healthcare claim submitted for reimbursement; selecting data from the data base to compare to a set of rules using an audit module; comparing the selected data to the set of rules using the audit module, wherein the set of rules includes a history rule, quantity rule, unbundled rule, multidisciplinary rule, interpretation rule, timing rule, coding rule, or any combination thereof, for detecting and identifying fraud; using the audit module to automatically identify suspected fraudulent data when the selected data violates at least one rule of the set of rules; using the audit module to flag the fraudulent data; using the audit module to generate a report illustrating patterns of irregularities within the source data to visually identify the fraudulent data displayed within the source data by user-friendly graphs and charts; and generating at least one automated statement for display to identify the at least one rule of the set of rules that was violated by the selected data using a documentation module.