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WO2004046882A3 - Fraud and abuse detection and entity profiling in hierarchical coded payment systems - Google Patents

Fraud and abuse detection and entity profiling in hierarchical coded payment systems Download PDF

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Publication number
WO2004046882A3
WO2004046882A3 PCT/US2003/036888 US0336888W WO2004046882A3 WO 2004046882 A3 WO2004046882 A3 WO 2004046882A3 US 0336888 W US0336888 W US 0336888W WO 2004046882 A3 WO2004046882 A3 WO 2004046882A3
Authority
WO
WIPO (PCT)
Prior art keywords
fraud
hierarchical coded
entity
payment systems
abuse
Prior art date
Application number
PCT/US2003/036888
Other languages
French (fr)
Other versions
WO2004046882A2 (en
WO2004046882B1 (en
Inventor
Nallan C Suresh
Traversay Jean De
Hyma Gollamudi
Anu K Pathria
Michael K Tyler
Original Assignee
Fair Isaac Corp
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
Priority claimed from US10/295,589 external-priority patent/US8666757B2/en
Application filed by Fair Isaac Corp filed Critical Fair Isaac Corp
Priority to EP03786816A priority Critical patent/EP1561178A4/en
Priority to AU2003295619A priority patent/AU2003295619A1/en
Publication of WO2004046882A2 publication Critical patent/WO2004046882A2/en
Publication of WO2004046882A3 publication Critical patent/WO2004046882A3/en
Publication of WO2004046882B1 publication Critical patent/WO2004046882B1/en

Links

Classifications

    • 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
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/02—Banking, e.g. interest calculation or account maintenance

Landscapes

  • Business, Economics & Management (AREA)
  • Accounting & Taxation (AREA)
  • Finance (AREA)
  • Engineering & Computer Science (AREA)
  • Development Economics (AREA)
  • Economics (AREA)
  • Marketing (AREA)
  • Strategic Management (AREA)
  • Technology Law (AREA)
  • Physics & Mathematics (AREA)
  • General Business, Economics & Management (AREA)
  • General Physics & Mathematics (AREA)
  • Theoretical Computer Science (AREA)
  • Medical Treatment And Welfare Office Work (AREA)
  • Financial Or Insurance-Related Operations Such As Payment And Settlement (AREA)

Abstract

Fraud and abuse detection in an entity's payment coding practices includes the ability to search for fraud at all levels of the hierarchical coded payment system within the context of an unsupervised model. The model uses variables derived and profiles created at any level or at all levels of the hierarchical coded payment system to create a comprehensive description of the payment coding activities submitted by the entity. That description is compared with other peer entities to determine unusual and To potentially inappropriate activity. The profiles created may themselves be utilized for purposes other than the detection of fraud and abuse.
PCT/US2003/036888 2002-11-15 2003-11-14 Fraud and abuse detection and entity profiling in hierarchical coded payment systems WO2004046882A2 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP03786816A EP1561178A4 (en) 2002-11-15 2003-11-14 Fraud and abuse detection and entity profiling in hierarchical coded payment systems
AU2003295619A AU2003295619A1 (en) 2002-11-15 2003-11-14 Fraud and abuse detection and entity profiling in hierarchical coded payment systems

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/295,589 2002-11-15
US10/295,589 US8666757B2 (en) 1999-07-28 2002-11-15 Detection of upcoding and code gaming fraud and abuse in prospective payment healthcare systems

Publications (3)

Publication Number Publication Date
WO2004046882A2 WO2004046882A2 (en) 2004-06-03
WO2004046882A3 true WO2004046882A3 (en) 2004-08-05
WO2004046882B1 WO2004046882B1 (en) 2004-09-30

Family

ID=32324344

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2003/036888 WO2004046882A2 (en) 2002-11-15 2003-11-14 Fraud and abuse detection and entity profiling in hierarchical coded payment systems

Country Status (3)

Country Link
EP (1) EP1561178A4 (en)
AU (1) AU2003295619A1 (en)
WO (1) WO2004046882A2 (en)

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US7665063B1 (en) 2004-05-26 2010-02-16 Pegasystems, Inc. Integration of declarative rule-based processing with procedural programming
US8732004B1 (en) 2004-09-22 2014-05-20 Experian Information Solutions, Inc. Automated analysis of data to generate prospect notifications based on trigger events
GB2418499A (en) * 2004-09-24 2006-03-29 Advanced Forensic Solutions Lt Information analysis arrangement
US8924335B1 (en) 2006-03-30 2014-12-30 Pegasystems Inc. Rule-based user interface conformance methods
US8036979B1 (en) 2006-10-05 2011-10-11 Experian Information Solutions, Inc. System and method for generating a finance attribute from tradeline data
US7657569B1 (en) 2006-11-28 2010-02-02 Lower My Bills, Inc. System and method of removing duplicate leads
US7778885B1 (en) 2006-12-04 2010-08-17 Lower My Bills, Inc. System and method of enhancing leads
US8606626B1 (en) 2007-01-31 2013-12-10 Experian Information Solutions, Inc. Systems and methods for providing a direct marketing campaign planning environment
US8606666B1 (en) 2007-01-31 2013-12-10 Experian Information Solutions, Inc. System and method for providing an aggregation tool
US8250525B2 (en) 2007-03-02 2012-08-21 Pegasystems Inc. Proactive performance management for multi-user enterprise software systems
US7975299B1 (en) 2007-04-05 2011-07-05 Consumerinfo.Com, Inc. Child identity monitor
WO2008147918A2 (en) 2007-05-25 2008-12-04 Experian Information Solutions, Inc. System and method for automated detection of never-pay data sets
US11037229B2 (en) * 2008-02-29 2021-06-15 Scott Zoldi Fraud detection system for the faster payments system
US10373198B1 (en) 2008-06-13 2019-08-06 Lmb Mortgage Services, Inc. System and method of generating existing customer leads
US7991689B1 (en) 2008-07-23 2011-08-02 Experian Information Solutions, Inc. Systems and methods for detecting bust out fraud using credit data
US20100174638A1 (en) 2009-01-06 2010-07-08 ConsumerInfo.com Report existence monitoring
US8843435B1 (en) 2009-03-12 2014-09-23 Pegasystems Inc. Techniques for dynamic data processing
US8468492B1 (en) 2009-03-30 2013-06-18 Pegasystems, Inc. System and method for creation and modification of software applications
US9652802B1 (en) 2010-03-24 2017-05-16 Consumerinfo.Com, Inc. Indirect monitoring and reporting of a user's credit data
US10453093B1 (en) 2010-04-30 2019-10-22 Lmb Mortgage Services, Inc. System and method of optimizing matching of leads
EP2676197B1 (en) 2011-02-18 2018-11-28 CSidentity Corporation System and methods for identifying compromised personally identifiable information on the internet
US8880487B1 (en) 2011-02-18 2014-11-04 Pegasystems Inc. Systems and methods for distributed rules processing
US11030562B1 (en) 2011-10-31 2021-06-08 Consumerinfo.Com, Inc. Pre-data breach monitoring
US9195936B1 (en) 2011-12-30 2015-11-24 Pegasystems Inc. System and method for updating or modifying an application without manual coding
US10255598B1 (en) 2012-12-06 2019-04-09 Consumerinfo.Com, Inc. Credit card account data extraction
US8812387B1 (en) 2013-03-14 2014-08-19 Csidentity Corporation System and method for identifying related credit inquiries
US9633322B1 (en) 2013-03-15 2017-04-25 Consumerinfo.Com, Inc. Adjustment of knowledge-based authentication
US10262362B1 (en) 2014-02-14 2019-04-16 Experian Information Solutions, Inc. Automatic generation of code for attributes
US10469396B2 (en) 2014-10-10 2019-11-05 Pegasystems, Inc. Event processing with enhanced throughput
US10339527B1 (en) 2014-10-31 2019-07-02 Experian Information Solutions, Inc. System and architecture for electronic fraud detection
US10445152B1 (en) 2014-12-19 2019-10-15 Experian Information Solutions, Inc. Systems and methods for dynamic report generation based on automatic modeling of complex data structures
US11151468B1 (en) 2015-07-02 2021-10-19 Experian Information Solutions, Inc. Behavior analysis using distributed representations of event data
US10698599B2 (en) 2016-06-03 2020-06-30 Pegasystems, Inc. Connecting graphical shapes using gestures
US10698647B2 (en) 2016-07-11 2020-06-30 Pegasystems Inc. Selective sharing for collaborative application usage
US10699028B1 (en) 2017-09-28 2020-06-30 Csidentity Corporation Identity security architecture systems and methods
US10896472B1 (en) 2017-11-14 2021-01-19 Csidentity Corporation Security and identity verification system and architecture
US11048488B2 (en) 2018-08-14 2021-06-29 Pegasystems, Inc. Software code optimizer and method
US11567945B1 (en) 2020-08-27 2023-01-31 Pegasystems Inc. Customized digital content generation systems and methods
CN112926879B (en) * 2021-03-26 2022-05-20 平安科技（深圳）有限公司 Payment scheme decision method, device and equipment for disease diagnosis related grouping
CN113487316B (en) * 2021-07-22 2024-05-03 银清科技有限公司 Distributed payment system security processing method and device

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5253164A (en) * 1988-09-30 1993-10-12 Hpr, Inc. System and method for detecting fraudulent medical claims via examination of service codes
US5577169A (en) * 1994-04-29 1996-11-19 International Business Machines Corporation Fuzzy logic entity behavior profiler

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5253164A (en) * 1988-09-30 1993-10-12 Hpr, Inc. System and method for detecting fraudulent medical claims via examination of service codes
US5577169A (en) * 1994-04-29 1996-11-19 International Business Machines Corporation Fuzzy logic entity behavior profiler

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
FEDERAL REGISTER, DEP. OF HEALTH AND HUMAN SERVICES, PART II, 12 May 1998 (1998-05-12), XP008109706 *
See also references of EP1561178A4 *

Also Published As

Publication number Publication date
AU2003295619A8 (en) 2004-06-15
EP1561178A2 (en) 2005-08-10
EP1561178A4 (en) 2009-08-12
WO2004046882A2 (en) 2004-06-03
AU2003295619A1 (en) 2004-06-15
WO2004046882B1 (en) 2004-09-30

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