Systems and Methods for Reducing Medical Claims Fraud

Abstract

Various embodiments of the present disclosure may be comprised of systems and methods for reducing fraudulent use of a medical identity to obtain medical goods or services. Identification information may be received for a medical insurance account of a medical consumer. Medical claims data associated with the medical insurance account may be received, and the medical claims data may be transmitted to the medical consumer. A confirmation status may be received from the medical consumer for the medical claims data.

1 . (canceled) 
     
     
         2 . A method in a computing system, comprising:
 in a first computing device:
 receiving a pending medical insurance claim, the pending medical insurance claim identifying a patient and indicating 
 a particular medical service as having been rendered to the identified patient; 
 determining an electronic address associated with the identified patient; 
 using the determined electronic address to transmit information describing the indicated medical service to a second computing device distinct from the first computing device; 
   in the second computing device:
 receiving the information describing the indicated medical service transmitted by the first device; 
 displaying a description of the indicated medical service based on the received information; 
 obtaining user input indicating whether the indicated medical service was actually rendered to the identified patient; 
 transmitting an indication of the obtained user input to the first computing device; 
   in the first computing device:
 receiving the indication transmitted by the second device; and 
 setting a status for the received pending medical insurance claim that is based on the received indication. 
   
     
     
         3 . The method of  claim 2  wherein the second device is a mobile device. 
     
     
         4 . The method of  claim 2  wherein the first device is a server. 
     
     
         5 . The method of  claim 2 , further comprising:
 in the first computing device:
 in response to the status set for the received pending medical insurance claim, causing the received pending medical insurance claim to be paid. 
   
     
     
         6 . The method of  claim 2 , further comprising:
 in the first computing device:
 in response to the status set for the received pending medical insurance claim, causing the received pending medical insurance claim to be denied. 
   
     
     
         7 . The method of  claim 2 , further comprising:
 in the first computing device:
 in response to the status set for the received pending medical insurance claim, causing the received pending medical insurance claim to be investigated. 
   
     
     
         8 . The method of  claim 2  wherein the description of the indicated medical service displayed in the second computing device includes a medical service provider name. 
     
     
         9 . The method of  claim 2  wherein the description of the indicated medical service displayed in the second computing device includes a medical service type. 
     
     
         10 . The method of  claim 2  wherein the description of the indicated medical service displayed in the second computing device includes a medical service rendering date. 
     
     
         11 . A method in a computing system, comprising:
 obtaining information describing a medical service indicated by a medical insurance claim to have been rendered to a distinguished person;   transmitting the obtained information to a device associated with the distinguished person;   receiving from the device associated with the distinguished person an indication of user input received by the device associated with the distinguished person indicating whether the described medical service was actually rendered to the distinguished person when the obtained information was presented on the device associated with the distinguished person; and   where the received indication indicates that the described medical service was not actually rendered to the distinguished person, flagging the medical insurance claim   
     
     
         12 . The method of  claim 11  wherein the device associated with the distinguished person is a mobile device. 
     
     
         13 . The method of  claim 11  wherein the method is performed in a server. 
     
     
         14 . The method of  claim 11 , further comprising:
 causing the received pending medical insurance claim to be denied.   
     
     
         15 . The method of  claim 11 , further comprising:
 causing the received pending medical insurance claim to be investigated.   
     
     
         16 . A memory having contents configured to cause a computing device associated with a distinguished person to perform a method, the method comprising:
 receiving information describing a medical service indicated by a medical insurance claim to have been rendered to the distinguished person;   displaying the received information;   prompting for user input indicating whether the described medical service was actually rendered to the distinguished person;   receiving user input indicating whether the described medical service was actually rendered to the distinguished person; and   transmitting an indication of the received user input to a separate computing device as a basis for determining that the medical insurance claim is suspicious.   
     
     
         17 . The memory of  claim 16  wherein the computing device associated with the distinguished person is a mobile device. 
     
     
         18 . The memory of  claim 16  wherein the separate computing device is a server. 
     
     
         19 . The memory of  claim 16  wherein the displayed information comprises a medical service provider name. 
     
     
         20 . The memory of  claim 16  wherein the displayed information comprises a medical service type. 
     
     
         21 . The memory of  claim 16  wherein the displayed information comprises a medical service rendering date.