WO2000035341A2

WO2000035341A2 - Apparatus and methods for reducing billing fraud

Info

Publication number: WO2000035341A2
Application number: PCT/US1999/030200
Authority: WO
Inventors: James E. Beecham
Original assignee: Beecham James E
Priority date: 1998-12-18
Filing date: 1999-12-17
Publication date: 2000-06-22
Also published as: AU2710900A; WO2000035341A3

Abstract

A system comprising a benefactor having a database of biometric data of at least one member customer (13), the benefactor for providing payment to at least one member provider (12) for providing a product to the member customer (13), and the member provider (12) having a biometric data collection and billing facility for recording biometric data, associating the biometric data to at least one statement reflecting billings for at least one furnished product, and sending the statement to the benefactor.

Description

APPARATUS AND METHODS FOR REDUCING BILLING FRAUD

TECHNICAL FIELD

This invention relates to biometrics and, more particularly, to a biometric-based system, method and apparatus for reducing billing fraud.

BACKGROUND ART

Fraudulent billing is a persistent problem in many service-oriented fields, especially the medical field. It is estimated that fraud in the Medicare program costs fifty million dollars per day in the United States. Can. Med. Assoc. J.; April 15, 1997, 156-58. When a patient receives a service or medical treatment from provider, a bill for services is sent to Medicare by the provider or benefactor in the name of the patient. Fraudulent claims are found in billings for services not performed and double billings. Investigators have found fraud in all segments of the health care system, from physicians and hospitals to nursing-home operators, providers of patient transportation and laboratory and clinic operators. Orders for goods and services can also be forged. It would be very useful to provide a billing system that resists fraudulent billing.

Given these and other shortcomings in the art, the need for certain new and useful improvements is evident. DISCLOSURE OF THE INVENTION

The invention proposes a new and improved billing system for associating customer biometric data to customer billing statements and activities. By doing so, the invention reduces or at least substantially eliminates billing fraud between product providers and benefactors such as insurance companies. In a particular embodiment, the system is comprised of a benefactor having a database of biometric data of at least one member customer and at least one member product provider. The benefactor receives bills or statements from the member product provider, which it pays on behalf of the member customer. The bills or statements reflect fees for a product or products furnished to the member customer by the member product provider. The member product provider has a biometric data collection and billing facility for recording biometric data of the member customer, associating the biometric data to a member customer statement reflecting billings for at least one furnished product, and sending the statement to the benefactor for payment. The product may comprise one or more goods and/or services. By comparing the biometric data on the statement to the biometric data stored in the database, the benefactor can authenticate the statement to ensure it is not fraudulent. Associated methods may also be provided.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and further and more specific objects and advantages of the invention will become readily apparent to those skilled in the art from the following detailed description thereof taken in conjunction with the drawings in which:

Fig. 1 illustrates a customer and a biometric data collection and billing facility; Fig. 2 illustrates a photograph being taken of the customer of Fig. 1 ;

Fig. 3 illustrates a statement of fees for a product furnished to a customer;

Fig. 4 illustrates the statement of Fig. 3 present at a benefactor office; and

Fig. 5 illustrates a customer reviewing the statement of Fig. 4.

BEST MODES FOR CARRYING OUT THE INVENTION

Ensuing embodiments of the invention comprise a new and improved system and method for reducing or at least substantially inhibiting fraudulent billing practices by associating customer biometric data to customer billing statements. This invention is especially useful for insurance companies or benefactors that are responsible for paying bills for its member customers that, are furnished with a product, whether goods or services, from its member product providers. The member product providers can be doctors, counselors, pharmacies or other product or service providers. To provide biometric identification, the invention utilizes biometric data of a portion of the anatomy of that person. Biometric data or measurements can include fingerprint or iris patterns, or measurement ( s ) of an anatomical function such as signature or voice recognition or voice print, etc. Various biometric measurements or data and methods of collecting the measurements or data are disclosed in U.S. patent application serial number 08/686,211, filed on 23 July

1996 and entitled "Method, Apparatus and System for

Anonymous Verification of Infectious Status of Humans" which is an invention of the same inventor and which is owned by the same entity, and hereby incorporated by reference herein. The teachings of PCT application serial number PCT/US99/08120, filed on 14 April 1999 and entitled "Method, System and Apparatus for Biometric Identification" and U.S. provisional application serial number 60/112,968, filed 18 December 1998 and entitled "Method System and Apparatus for Reducing Fraud m Medical Billing" are also incorporated by reference herein. The biometric data are then encoded into biometric code for storage in a database of a computer or other storage device. Encoding typically takes place during the process of obtaining biometric data.

Regarding Fig. 1, shown is biometric data collection and billing facility having a computer 17, an attached iris scanner 15, an attached two-dimensional bar code printer 16 and a digital camera 14. In this embodiment, member product provider 12 is to furnish customer 13 with a product, whether one or more goods and/or services. In consideration for the product, provider 12 charges a fee. In this embodiment, and throughout this disclosure, provider 12 is a member of a profession or affiliated provider for an insurance company or benefactor. Customer 13 has insurance that the benefactor provides. To have the insurance, customer 13 normally pays fees to the benefactor. Because customer 13 has insurance provided by the benefactor, the benefactor receives bills or statements from product provider 12 for at least some or all of the fees incurred by customer 13 for receiving product from provider 12. The benefactor pays these fees. Data identifying customer 13 is stored m a database of the benefactor. Computer 17 preferably comprises a rugged personal computer such as provided by Mellard Technologies of

Amonk, New York, USA. Iris scanner 15 may comprise any one of a variety of conventional iris scan devices such as that from IriScan company of Mt . Laurel New Jersey. Computer 17 can be coupled to one or more other computers by way of one or more communication pathways such as a conventional phone line, an Internet-based communication pathway, a wireless local area network, a worldwide area network or a ground or satellite-based communication network. Computer 17 includes a processor that can, for instance, be programmed by software to prompt provider 12 to collect biometric data from customers such as customer 13.

In terms of this invention, it is important for customer 13 to verify he or she actually received the product from provider 12. This verification is, in accordance with this invention, embodied in a statement for fees that the provider of the product then provides to the customer's benefactor for payment. In this regard, shortly before, during or shortly after provider 12 provides customer 13 with a product, a biometric sample may be taken of customer 13, which is then stored in computer 17 as biometric data in a customer file. This customer file is linked to the date and time on computer 17 and to the type of product provided by provider 12. All of this data is then printed onto a two-dimensional bar code along with, for instance, a digital photograph of customer 13. A digital photograph of customer 13 may be downloaded to computer 17 in a conventional manner, and then linked to the customer file.

In Fig. 2, customer 13 is photographed by provider 12 at the time of provider 12 provides customer 13 with a product. As a matter of authentication, customer 13 may hold a newspaper 21 or other printed publication of the day the photograph is taken to verify customer 13 was photographed at least on or after the date the newspaper bears. Biometric data may comprise, in addition to an iris scan, details concerning individual medical history including past medical conditions.

Turning now to Fig. 3, shown is a statement 33 of fees for a product furnished to customer 13. Printer 16 in Fig. 1 preferably generates statement 33 from computer 17. In accordance with the invention, provider 12 affixes a two-dimensional bar code 31 onto statement 33. Two-dimensional bar code 31 contains biometric data of customer 13 in the form of a biometric code. Bar code 31 may be affixed to statement 33 with an adhesive, or perhaps printed directly onto statement 33. Bar code 31 contains, for instance, an encoded iris code 37 of customer 13, a digital photograph 39 of customer 13, date/time information 35 as well as a code 38 identifying the nature of the product provided to customer 13.

In Fig. 4, statement 33 is illustrated as it may appear at a benefactor office having a computer 41. Statement 33 may be mailed or physically delivered to the benefactor office, or sent from computer 17 (Fig. 1) to computer 41 over the Internet via electronic mail or over a wired or wireless communication pathway. Stored in a database of computer 41 is the biometric code data of all of its members, which was previously collected and stored m a fashion consistent with this disclosure.

The biometric code data stored in the database of computer 41 is preferably the same type of bionief - data contained by statement 33. By using a bar code scanner 47 attached to computer 41, auditor 49 at the benefactor office can scan bar code 31 for transferring the data contained thereon to computer 41. Auditor 49 can view the data contained by bar code 31 on a computer screen. In this regard, auditor 49 can view digital photograph 39, newspaper 21, etc. By viewing the bar code data taken from bar code 31, auditor 49 can verify that customer 13 was at the location stated by provider

12 in statement 33. At this point, auditor 49 may access the database of computer 41, access the file of biometric data of customer 13 stored in the database and then compare the biometric data of the file and bar code 31. Rather than manually accessing computer 41 database, computer 41 may be configured and activated to search its database for a file having biometric data that matches that of the biometric data taken from bar code 31. If the comparison shows a match, or at least a substantial match, between the biometric data of customer 13 stored in the file of the computer 41 database and the biometric data of bar code 31, auditor may then make appropriate payment to provider 12 for the furnished product. If, however, the comparison fails to show a match between the biometric data of customer 13 stored in the file of the computer 41 database and the biometric data of bar code 31, auditor may then deny payment to provider 12 for the furnished or allegedly furnished services. When the biometric data of customer

13 stored m the file of the computer 41 data base is accessed, it is normally displayed on a screen of computer at, for instance, reference numeral 43. The biometric data taken from bar code 31 may be disoiayeα at reference number 45. By providing a s lmu 1 taπeo'„^c display of this biometric data, visual comparisons may be readily made. In lieu of a visual comparison, computer 41 can be configured to initiate a computerized comparison.

Turning now to Fig. 5, customer 13 can visit a benefactor office and review all statements submitted on her behalf. By submitting a biometric sample to biometric scanner 15, which may comprise an iris scanner, computer 17 may be configured to authenticate customer 13 prior to bringing up the statement (s) of customer 13. If customer 13 finds a fraudulent statement, customer 13 can notify the benefactor. In consideration for finding a fraudulent statement, benefactor can pay customer 13 a reward. This process of statement review can be made not only at the location of benefactor, but also at a remote location from a computer of customer 13. The computer of customer 13 can be linked to the benefactor computer, such as over the Internet or by way of one or more conventional communication pathways, to automatically or systematically receive notice of any billing in the name of customer 13 where the biometric data of customer 13 is linked to, for instance, an electronic mail address for customer 13.

It is anticipated that providers who must verify that a customer was present at the time of the furnishing of a product will be deterred from billing fraudulently. The provider would be less likely to send a bill when the patient was not in fact present and did not receive the product for which a fraudulent bill would be otherwise sent. Furthermore, the invention should deter providers from submitting fraudulent bills because the invention provides customers with the ability to view their bills. Additionally, where a customer has verified a product provided via iris scan or other form of biometric data that in fact was not provided, that customer becomes a co-conspirator in fraudulent billing should the customer verify a service not given. This should be a deterrent, because the customer would then be potentially liable for fraud in addition to the provider.

It will occur to those skilled in the art that the invention herein disclosed as preferred embodiment is for illustrative purposes. Various changes and modifications to the embodiments herein chosen for purposes of illustration will readily occur to those skilled in the art. For example, it is envisioned that the system of monitoring disclosed can provide statistical data useful for gathering fraud statistics and to verify identity of purportedly disabled persons in relation to their disability and services received. Other uses of the invention are envisioned to be a network of computers for managing medical billing by insurance companies and other health care management organizations. To the extent such modifications and variations do not depart from the spirit of the invention, they are intended to be included within the scope thereof.

Claims

1 . A system comprising : a benefactor having a database of biometric data of at least one member customer, the benefactor for providing payment to at least one member provider for providing a product to the member customer; and the member provider having a biometric data collection and billing facility for recording biometric data, associating the biometric data to at least one statement reflecting billings for at least one furnished product, and sending the statement to the benefactor.

2. The system of claim 1, wherein the biometric data collection and billing facility records the biometric data in the form of biometric code data.

3. The system of claim 1, wherein the database of biometric data further includes a database of biometric code data.

4. The system of claim 1, wherein the biometric data collection and billing facility includes a printer for printing a two-dimensional bar code encoded with biometric code data of the member customer.

5. The system of claim 1, wherein the biometric data collection and billing facility is coupled in data communication to the database over a communication pathway.

6. The system of claim 5, wherein the communication pathway is wireless.

7. The system of claim 5, wherein the communication pathway is a ground-based communication pathway.

8. The system of claim 5, wherein the communication pathway is a satellite-based communication pathway.

9. The system of claim 4, wherein the benefactor has at least one station having a reader for reading two-dimensional bar codes, storing biometric code data of two-dimensional bar codes and searching the database for matching biometric code data.

10. A method for billing a benefactor for fees for a product furnished to a member customer from a member provider comprising the steps of: collecting reference biometric data of the member customer; storing the biometric data in a benefactor database; collecting biometric data of the member customer at the member provider; associating the biometric data with a statement of fees for a product furnished to the member customer from the member provider; sending the statement to the benefactor; comparing the biometric data to the reference biometric data; and only if the biometric data substantially matches the reference biometric data, the benefactor paying the member provider for the fees reflected in the statement.

11. The method of claim 10, wherein the step of collecting reference biometric data further includes the step of collecting iris scan data.

12. The method of claim 10, wherein the step of collecting biometric data further includes the step of collecting iris scan data.

13. The method of claim 10, wherein the step of collecting reference biometric data further includes the step of recording reference biometric code data defining the reference biometric data.

14. The method of claim 10, wherein the step of collecting biometric data further includes the step of recording biometric code data defining the biometric data.

15. The method of claim 10, wherein the step of storing the reference biometric data further includes the step of storing reference biometric code data defining the reference biometric data.

16. The method of claim 10, wherein the step of associating the biometric data with a statement further includes the step of affixing a two-dimensional bar code of the biometric data to the statement.