PATENT MATRIX

Key Words Corruption, Dishonesty, Fraud, Health sector, Medical management, Health
protection, ICT, Computer Technology , Artificial
intelligence.____________________________________________________________________________________
Real World Problem_ Information and Communication Technology based interventions: to combat
corruption in Health care department of Sindh, Pakistan :A Case study of Civil hospital
Hyderabad.Proposed

Solution: Research will provide involvement of ICT in controlling corruption in health care department.

Title IPC Inventor Assignee Claims

1 1. . An adaptive method for healthcare claim fraud detection,
 G06Q10/10  Akli Adjaoute comprising:
Healthcare Brighterion Inc a data reduction step for converting claim data into profile data
fraud protection comprising a plurality of behavioral dimensions, wherein a
minimum of a hundred fold reduction in data volume is realized;
and an individual recognition step for identifying individual healthcare
management providers in said profile data and for collecting such into
corresponding long term individual healthcare provider profiles;
a clustering step for identifying groups of healthcare providers in
said profile data and for collecting such into respective long term
group profiles;
a smart agent building step for feeding historical claim data
through the data reduction step to the individual recognition step
and the group recognition step, and for creating a plurality of
individual and group smart agents therefrom and each including
 profile data organized into said plurality of behavioral
dimensions;
an updating step for using claim data fed through the data
reduction step to be added to any matching long term individual
healthcare provider profile;
a real time fraud detection step for comparing updates of
individual ones of the plurality of behavioral dimensions to their
running values in the long term individual healthcare provider
profiles and measuring any significant deviations;
a fraud classification step for scoring said deviations as being
the result of fraudulent or non-fraudulent behavior on the part of
the respective individual healthcare provider having sourced the
claim data;
wherein, the step of updating produces a self-learning and
adaptive fraud detection capability that evolves over time
healthcare provider-by-healthcare provider.

2.  The method of claim 1, further comprising:

a non-fraudulent classification step for dividing score
determinations of non-fraudulent behavior into ones requiring
and not requiring further investigation
.

3. The method of claim 1, further comprising:

a group classification step for comparing updates of individual
ones of the plurality of behavioral dimensions to their running
values in related long term group healthcare provider profiles,
and for measuring any significant deviations from other
members in the group
2
Richard 1. . A centralized healthcare management and monitoring
System and Postrel
No current
G16H10/65 assignee system comprising:
method for a. a healthcare management server computer interconnected to
centralized a computer network, the healthcare management server
computer comprising:
management i. a first repository of patient records, each patient record
and monitoring associated with a patient and accessible via a unique patient
identification indicia associated with the patient, each patient
of healthcare record comprising healthcare information associated with the
services patient; and
ii. a second repository of predetermined compliance rules; each
of the compliance rules comprising information regarding an
interaction between multiple entities associated with the
healthcare management server computer;
b. a plurality of healthcare provider computers interconnected to
the computer network, each of which is associated with a
healthcare provider, each of the healthcare provider computers
comprising means for inputting a patient identification indicia
presented by a patient and communicating with the healthcare
management server computer over the computer network using
the patient identification presented by the patient;
wherein, when a patient presents, in association with healthcare
services performed by the associated healthcare provider, a
patient identification indicia associated with the patient, the
healthcare provider computer transmits to the healthcare
management server computer a query comprising parameters
comprising:
the patient identification indicia;
an identification of the healthcare services performed or
proposed to be performed by the associated healthcare
provider; and
an identification of the healthcare provider performing the
healthcare services; and
the healthcare management server computer utilizes the query
to access the first and second repositories to determine if the
parameters of the query are in compliance with one or more of
the predetermined compliance rules.
. A centralized healthcare management and monitoring system
comprising:
a. a healthcare management server computer interconnected to
a computer network, the healthcare management server
computer comprising:
i. a first repository of patient records, each patient record
associated with a patient and accessible via a unique patient
identification indicia associated with the patient, each patient
record comprising healthcare information associated with the
patient; and
ii. a second repository of predetermined compliance rules; each
of the compliance rules comprising information regarding an
interaction between multiple entities associated with the
healthcare management server computer;
b. a plurality of healthcare provider computers interconnected to
the computer network, each of which is associated with a
healthcare provider, each of the healthcare provider computers
comprising means for inputting a patient identification indicia
presented by a patient and communicating with the healthcare
management server computer over the computer network using
the patient identification presented by the patient;
wherein, when a patient presents, in association with healthcare
services performed by the associated healthcare provider, a
patient identification indicia associated with the patient, the
healthcare provider computer transmits to the healthcare
 management server computer a query comprising parameters
comprising:
the patient identification indicia;
an identification of the healthcare services performed or
proposed to be performed by the associated healthcare
provider; and
an identification of the healthcare provider performing the
healthcare services; and
the healthcare management server computer utilizes the query
to access the first and second repositories to determine if the
parameters of the query are in compliance with one or more of
the predetermined compliance rules.

2. he system of claim
1 wherein the
compliance rules
comprise rules related to
healthcare treatment
procedures, and wherein
the healthcare
management server
computer determines if
the healthcare services
proposed to be
performed by the
healthcare provider
identified in the query are
in compliance with the
healthcare treatment
procedures.

3 The system of claim 2 wherein healthcare information

associated with the patient identified in the query is utilized by
the healthcare management server computer to determine if the
healthcare services proposed to be performed by the healthcare
provider identified in the query are in compliance with the
healthcare treatment procedur.
3 1. A method, comprising:
G06Q10/10  Jeffrey M. Verizon Patent receiving, by one or more devices, healthcare information;
Healthcare Getchius and Licensing calculating, by the one or more devices, a geographic density of
fraud detection Inc healthcare fraud based on the healthcare information;
determining, by the one or more devices, anomalous
with machine distributions of healthcare fraud based on the healthcare
learning information;
deriving, by the one or more devices, empirical estimates of
procedure and treatment durations based on the healthcare
 information;
utilizing, by the one or more devices, classifiers to determine
first inconsistencies in the healthcare information;
utilizing, by the one or more devices, language models and co-
morbidity analysis to determine second inconsistencies in the
healthcare information;
utilizing, by the one or more devices, link analysis to determine
third inconsistencies in the healthcare information;
calculating, by the one or more devices, parameters for a
healthcare fraud detection system based on the geographic
density, the anomalous distributions, the empirical estimates,
and the first, second, and third inconsistencies; and
providing, by the one or more devices, the parameters to the
healthcare fraud detection system.

2. The method of claim

1, where the one or more
devices are provided in a
healthcare fraud analysis
system.

3. The method of claim 2, where the healthcare fraud analysis

system and the healthcare fraud detection system are provided
in a healthcare fraud management system.
4 1.
2.
3.

5 1.
2.
3.

©Dr. Arabella Bhutto @ MUET