WO2002021313A3 - Unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions and associated computer software program product, computer device, and system - Google Patents

Unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions and associated computer software program product, computer device, and system Download PDF

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Publication number
WO2002021313A3
WO2002021313A3 PCT/US2001/027516 US0127516W WO0221313A3 WO 2002021313 A3 WO2002021313 A3 WO 2002021313A3 US 0127516 W US0127516 W US 0127516W WO 0221313 A3 WO0221313 A3 WO 0221313A3
Authority
WO
WIPO (PCT)
Prior art keywords
respect
transactions
entity
healthcare
program product
Prior art date
Application number
PCT/US2001/027516
Other languages
French (fr)
Other versions
WO2002021313A2 (en
Inventor
Samir Ibrahim Abed
Michael Yvan Wallace
Aaron Michael Seib
David Stanton Whipple
Paul A Dubose
Original Assignee
Bloodhound Software Inc
Samir Ibrahim Abed
Michael Yvan Wallace
Aaron Michael Seib
David Stanton Whipple
Paul A Dubose
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Bloodhound Software Inc, Samir Ibrahim Abed, Michael Yvan Wallace, Aaron Michael Seib, David Stanton Whipple, Paul A Dubose filed Critical Bloodhound Software Inc
Priority to AU2001287082A priority Critical patent/AU2001287082A1/en
Publication of WO2002021313A2 publication Critical patent/WO2002021313A2/en
Publication of WO2002021313A3 publication Critical patent/WO2002021313A3/en

Links

Classifications

    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/80—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for detecting, monitoring or modelling epidemics or pandemics, e.g. flu

Abstract

An unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions is provided. A coordinate space is defined with a dimensionality corresponding to a number of selected ranked variables defining a representative behavior of a peer group with respect to a reference source of claim transactions, the peer group comprising a plurality of entites. A central tendency of the representative behavior is then determined from the claim transactions of the reference source, as a result of the selected ranked variables being applied thereto, and with respect to the coordinate space. The selected ranked variables are then applied to a new source of claim transactions for entites corresponding to the peer group so as to define a corresponding element for each entity. After mapping the elements with respect to the coordinate space, a score is then determined for each element with respect to the central tendency. A threshold criteria is then applied to the scores such that a threshold-exceeding score indicates an aberrant behavior by the corresponding entity. An associated computer software program product, computer device, and system are also provided.
PCT/US2001/027516 2000-09-05 2001-09-05 Unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions and associated computer software program product, computer device, and system WO2002021313A2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2001287082A AU2001287082A1 (en) 2000-09-05 2001-09-05 Unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions and associated computer software program product, computer device, and system

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US23013600P 2000-09-05 2000-09-05
US60/230,136 2000-09-05

Publications (2)

Publication Number Publication Date
WO2002021313A2 WO2002021313A2 (en) 2002-03-14
WO2002021313A3 true WO2002021313A3 (en) 2003-06-12

Family

ID=22864075

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2001/027516 WO2002021313A2 (en) 2000-09-05 2001-09-05 Unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions and associated computer software program product, computer device, and system

Country Status (2)

Country Link
AU (1) AU2001287082A1 (en)
WO (1) WO2002021313A2 (en)

Families Citing this family (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8092380B2 (en) 2005-02-28 2012-01-10 Rothman Healthcare Corporation System and method for improving hospital patient care by providing a continual measurement of health
US20070219824A1 (en) * 2006-03-17 2007-09-20 Jean Rawlings System and method for identifying and analyzing patterns or aberrations in healthcare claims
US8126738B2 (en) 2006-04-28 2012-02-28 Mdi Technologies, Inc. Method and system for scheduling tracking, adjudicating appointments and claims in a health services environment
US8126739B2 (en) 2006-04-28 2012-02-28 MDI Technologies, Inc Method and system for tracking treatment of patients in a health services environment
CA2666379A1 (en) 2006-10-13 2008-04-17 Michael Rothman & Associates System and method for providing a health score for a patient
US8191053B2 (en) 2007-04-12 2012-05-29 Ingenix, Inc. Computerized data warehousing
FI20085340L (en) * 2008-04-22 2009-10-23 Medixine Oy Health screening and a method for implementing the health screening
CA2739793A1 (en) 2008-10-21 2010-04-29 Rothman Healthcare Corporation Methods of assessing risk based on medical data and uses thereof

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5359509A (en) * 1991-10-31 1994-10-25 United Healthcare Corporation Health care payment adjudication and review system
EP0681249A2 (en) * 1994-04-29 1995-11-08 International Business Machines Corporation Fuzzy logic entity behavior profiler
US5819226A (en) * 1992-09-08 1998-10-06 Hnc Software Inc. Fraud detection using predictive modeling
US5822741A (en) * 1996-02-05 1998-10-13 Lockheed Martin Corporation Neural network/conceptual clustering fraud detection architecture
US5835897A (en) * 1995-06-22 1998-11-10 Symmetry Health Data Systems Computer-implemented method for profiling medical claims

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5359509A (en) * 1991-10-31 1994-10-25 United Healthcare Corporation Health care payment adjudication and review system
US5819226A (en) * 1992-09-08 1998-10-06 Hnc Software Inc. Fraud detection using predictive modeling
EP0681249A2 (en) * 1994-04-29 1995-11-08 International Business Machines Corporation Fuzzy logic entity behavior profiler
US5835897A (en) * 1995-06-22 1998-11-10 Symmetry Health Data Systems Computer-implemented method for profiling medical claims
US5835897C1 (en) * 1995-06-22 2002-02-19 Symmetry Health Data Systems Computer-implemented method for profiling medical claims
US5822741A (en) * 1996-02-05 1998-10-13 Lockheed Martin Corporation Neural network/conceptual clustering fraud detection architecture

Also Published As

Publication number Publication date
WO2002021313A2 (en) 2002-03-14
AU2001287082A1 (en) 2002-03-22

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