Patent Number 6826537
Issue Date 2004 11 30
Inventor(s) Wood, Richard Glee
White, Jr., Wesley Jack
State/Country TX
Title: Cardless method for reducing fraud in government healthcare programs
Abstract: A method reducing fraud in a government healthcare program is described herein. The method includes registering a service provider with a healthcare provider and issuing a service provider identification code, registering at least one service of the service provider with the government sponsored healthcare provider and identifying a claim code for each registered service, issuing a code based on data from a biometric reading, a keypad entry with a PIN code, or an electronic signature pad entry to an individual related to a benefits program of the healthcare provider; using the code to determine if the individual is eligible for the healthcare program and performing three transmissions of information to reduce fraud in the systems. Exmp. Claim 1 Ex Claim text A method for reducing fraud in a government healthcare program consisting of: a. registering a service provider with a government healthcare provider and issuing a service provider identification code; b. registering at least one service or at least one good of the service provider with the government healthcare provider and identifying a claim code for each registered service or registered good; c. issuing and storing a first individual identification code to a first individual related to the government healthcare program, wherein the first individual identification code is linked to a biometric data of the first individual; d. comparing second biometric data from a second individual against the first individual identification code to determine if the second individual is eligible for benefits from the government healthcare program; c. facilitating a first transmission from the service provider to the government healthcare provider, wherein the first transmission comprises: i. the service provider identification code; ii. the individual identification code; iii. proposed information selected from the group consisting of proposed product information for the individual; proposed service information for the individual; corresponding claim codes for the proposed product; and corresponding claim codes for the proposed service; iv. an indication of medical need of the second individual; and v. a request to confirm: 1. the second individual's eligibility for benefits under the healthcare program; 2. a validation that the proposed good or service is approved for the second individual; 3. the service provider's eligibility to render services or provide goods under the healthcare program; and 4. a request to participate in an accelerated payment program for the proposed good or the proposed service; f. facilitating a second transmission from the government healthcare provider to the service provider, wherein the second transmission comprises: i. the second individual's eligibility for benefits under the government healthcare program; ii. a validation that the proposed good or proposed service is approved for the individual; iii. a validation of the service provider's eligibility to render services under the government healthcare program; iv. a confirmation that an accelerated payment program is available; v. an authorization code to provide the proposed product and/or proposed service; g. facilitating a third transmission from the service provider to the government healthcare provider, wherein the third transmission comprises: i. a claim codes list for services rendered; ii. acknowledgement by the second individual that information on the product and/or service was provided to the second individual; iii. acknowledgement that the product or service has been received from the service provider; and iv. a request for accelerated payment by the government healthcare provider to the service provider.
