Invention Grant
- Patent Title: Healthcare fraud preemption
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Application No.: US14454749Application Date: 2014-08-08
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Publication No.: US09779407B2Publication Date: 2017-10-03
- Inventor: Akli Adjaoute
- Applicant: Brighterion, Inc.
- Applicant Address: US CA San Francisco
- Assignee: Brighterion, Inc.
- Current Assignee: Brighterion, Inc.
- Current Assignee Address: US CA San Francisco
- Agent Louis Wu
- Main IPC: G06Q50/00
- IPC: G06Q50/00 ; G06Q30/00 ; G06Q40/08 ; G06Q50/22

Abstract:
Real-time fraud prevention software-as-a-service (SaaS) products include computer instruction sets to enable a network server to receive medical histories, enrollments, diagnosis, prescription, treatment, follow up, billings, and other data as they occur. The SaaS includes software instruction sets to combine, correlate, categorize, track, normalize, and compare the data sorted by patient, healthcare provider, institution, seasonal, and regional norms. Fraud reveals itself in the ways data points deviate from norms in nonsensical or inexplicable conduct. The individual behaviors of each healthcare provider are independently monitored, characterized, and followed by self-spawning smart agents that can adapt and change their rules as the healthcare providers evolve. Such smart agents will issue flags when their particular surveillance target is acting out of character, outside normal parameters for them. Fraud controls can therefore be much tighter than those that have to accommodate those of a diverse group.
Public/Granted literature
- US20150081324A1 HEALTHCARE FRAUD PREEMPTION Public/Granted day:2015-03-19
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