Debra Pacha
Radiology at Summer Oaks Ct, Oviedo, FL
License number
Florida 9781
Effective Date
Oct 29, 2004
Expiration Date
Nov 30, 2018
Category
Health Care
Type
Radiologic Technology
Address
Address
770 Summer Oaks Ct, Oviedo, FL 32765
Phone
(407) 359-9479
Professional information
System And Method For Detecting Healthcare Insurance Fraud
US Patent:
2011024, Oct 6, 2011
Filed:
Jun 16, 2011
Appl. No.:
13/162560
Inventors:
Debra Pacha - Oviedo FL, US
International Classification:
G06Q 40/00, G06Q 50/00
US Classification:
705 2, 705 4
Abstract:
A system and method for detecting healthcare insurance fraud is disclosed. The method includes creating a database containing source data related to at least one healthcare claim submitted for reimbursement, selecting data from the database to compare to a set of rules using an audit module, and comparing the selected data to the set of rules using the audit module. The method also includes using the audit module to automatically identify suspected fraudulent data when the selected data violates at least one rule of the set of rules and using the audit module to flag the fraudulent data. In addition, the method includes using the audit module to generate a report illustrating patterns of irregularities within the source data to visually identify the fraudulent data displayed within the source data by user-friendly graphs and charts, and generating at least one automated statement for display to identify the at least one rule of the set of rules that was violated by the selected data using a documentation module.
System And Method For Detecting Healthcare Insurance Fraud
US Patent:
2008014, Jun 12, 2008
Filed:
Nov 12, 2007
Appl. No.:
11/938582
Inventors:
Debra Pacha - Oviedo FL, US
Raul Ariza - Oviedo FL, US
Stephen Ratcliff - Oviedo FL, US
Raul Ariza - Oviedo FL, US
Stephen Ratcliff - Oviedo FL, US
International Classification:
G06N 5/02
US Classification:
706 47
Abstract:
The invention comprises a method and system of detecting and identifying fraud arising from a healthcare claim. The system includes a storage means for storing a data base containing source data related to a healthcare claim. A memory means is used for storing a set of user-defined rules for detecting and identifying fraud. A processing means is coupled to the storage means for comparing the source data to the set of rules in the memory means. If the source data violates the set of rules, the relevant portion of the source data is identified and flagged as fraudulent data. The flagged data is then forwarded to a special investigator for a comprehensive analysis. The fraudulent data is transformed to graphs and charts to illustrate patterns so that the fraud is easily detected and identified.