TECHNICAL FIELD

[0001] The present disclosure generally relates to the management of members of care facilities, attendance verification of attendance records of the members, and fraud prevention occurring in the same.

BACKGROUND

[0002] Adult day care facilities are an important component of a community- based service delivery system to provide vital daily living assistance to the elderly population. Facilities are equipped with a full range of interdisciplinary professionals to provide physical, psychological, social and even medical services to the members of these facilities.

[0003] Often the services provided at the facilities are paid for by third-party payors such as insurance companies or government agencies. Billing for the services rendered by the facility is processed by the facility itself, opening the door to false and/or fraudulent claims. For example, a facility might bill for services not provided and/or falsify a bill stating that the member was present for the services when in actuality the member was not. Other abuses include the recycling of attendance records, billing for more than the time actually provided, and not actually providing services during a member visit.

[0004] One attempt to prevent fraud was to provide the signature of a member at the time the services are provided. Unfortunately, forgery of a member's signature circumvented this safeguard to the filing of a false claim.

[0005] Attempts have been made to prevent fraud in the billing operations described above, none of which adequately address the problem at hand.

[0006] This disclosure describes improvements over these prior art technologies.

SUMMARY

[0007] Accordingly, a system for preventing fraud is provided. The system includes an authentication computer, comprising: a biometric reader; a first memory; a first processor programmed to: obtain member biometric data of at least one member from the biometric reader; store the member biometric data in the first memory with member data; obtain first biometric data of a person from the biometric reader at a check-in time the person arrives at a facility for services; and compare the first biometric data with the member biometric data to determine if the first biometric data matches the member biometric data; if the first biometric data matches the member biometric data, transmit over a network as first data the member data, a first time indicating when the first biometric data was obtained, and identification information of the biometric reader, and if the first biometric data does not match the member biometric data, set an override data flag for override data to be input by a user, transmit over the network as the first data the override data flag, a first time indicating when the override data was input, and the identification information of the biometric reader; and a server computer remote from the authentication computer, comprising: a second memory for storing at least member data, facility data, payor data and services data; and a second processor programmed to: receive over the network the first data; and store the first data in the second memory.

[0008] Accordingly a method for preventing fraud is provided. The method includes obtaining member biometric data of at least one member from a biometric reader; storing the member biometric data in a memory with member data; obtaining first biometric data of a person from the biometric reader at a check-in time the person arrives at a facility for services; transmitting the first biometric data from the biometric reader to a first processor; comparing by the first processor the first biometric data with the member biometric data to determine if the first biometric data matches the member biometric data; if the first biometric data matches the member biometric data, transmitting over a network to a second processor as first data the member data, a first time indicating when the first biometric data was obtained, and identification information of the biometric reader, and if the first biometric data does not match the member biometric data, setting an override data flag for override data to be input by a user, transmitting over the network to a second processor as the first data the override data flag, a first time indicating when the override data was input, and the identification information of the biometric reader; and storing the first data in a second memory.

BRIEF DESCRIPTION OF THE DRAWINGS

[0009] The present disclosure will become more readily apparent from the specific description accompanied by the attached drawings, in which:

[0010] FIG. 1 is a block diagram illustrating a system for preventing fraud according to the present disclosure;

[0011] FIG. 2 is a block diagram illustrating an authentication system according to the present disclosure;

[0012] FIG. 3 is a block diagram illustrating a server system according to the present disclosure;

[0013] FIG. 4 is a block diagram illustrating a service provider system according to the present disclosure;

[0014] FIG. 5 is a block diagram illustrating a payor system according to the present disclosure; and

[0015] FIGs. 6A, 6B and 6C is a flow diagram illustrating methods for preventing fraud according to the present disclosure.

[0016] Like reference numerals indicate similar parts throughout the figures.

DETAILED DESCRIPTION

[0017] The present disclosure may be understood more readily by reference to the following detailed description of the disclosure taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this disclosure is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed disclosure.

[0018] Also, as used in the specification and including the appended claims, the singular forms "a," "an," and "the" include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from "about" or "approximately" one particular value and/or to "about" or "approximately" another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment.

[0019] Reference will now be made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures.

[0020] FIG. 1 is a block diagram illustrating an embodiment of the present disclosure. A system 100 for managing activities, verifying attendance and/or preventing fraud is shown in FIG. 1. System 100 includes authentication computer 101 , server computer 102, service provider computer 103 and payor computer 104. Each of authentication computer 101 , service provider computer 103 and payor computer 104 are connected to server computer 102 via network 105. Network 105 can be, for example, the Internet, a wide area network (WAN), and/or local area network (LAN); other networks are contemplated. In addition, network 105 can be a single network or multiple networks as needed and based on system design. Also, in the present description authentication computer 101 , server computer 102, service provider computer 103 and payor computer 104 can include wired connections or wireless connections, for example, cellular or Wi-Fi.

[0021] Although system 100 is illustrated and described herein with only one authentication computer 101 , server computer 102, service provider computer 103 and payor computer 104, it will be understood that more than one of any or all of these components of system 100 can be included. For example, several service facilities might be owned by a single service provider that provides services to several members and receives payment from more than one payor company. In this example, at least one authentication computer 101 is located at each service facility sending data to server computer 102. The service provider is provided with at least one service provider computer 103 to interact with server computer 102 and have access to data associated with members being provided services by the service provider. Member data for each member is stored in the memory of one or more of the computers. The more than one payor company is provided with at least one payor computer 104 and provided access to data associated with the services being paid for by the payor company. The several computers interact with server computer 102 and server computer 102 provides access to only data to which service provider or payor company is authorized to access. System 100 can be configured for any number of service facilities, members, service providers and/or payors.

[0022] Authentication computer 101 includes processor 111 , biometric reader 112, memory 113, input device(s) 114 and output device(s) 115. Processor 111 is a specialty processor programmed to control the operation of authentication computer 101.

[0023] In a preferred embodiment biometric reader 112 is a facial recognition system, but other biometric readers are contemplated, for example, fingerprint scanner, eye scanner, etc. Biometric reader 112 can also include its own processor, memory and/or input/output devices as a preferred implementation.

[0024] Memory 113 is configured to store biometric data, member data and/or first and second data as needed. The data stored in memory 113 can also be cross- associated with other data, for example, member data can be associated with biometric data of the member and/or the first and second data of the member. Memory 113 is also configured to store programs for use by processor 111 to control the overall operation of authentication computer 101.

[0025] The biometric data can include initially obtained biometric data of a member as well as biometric data obtained from a member when services are provided.

[0026] The member data can include a member name, identification numbers including social security numbers, electronic signature information, etc., and can be modified and added to as needed.

[0027] The first and second data includes information associated with the obtaining of the biometric data of a member when services are provided, and can include a time the biometric data is obtained, identification information of the biometric reader itself, an override data flag(s), and/or override data. If more than two biometric readings are obtained and/or required, further data (e.g., third data) will be obtained.

[0028] The identification information of the biometric reader can include a serial number assigned to the biometric reader that is different from other biometric readers in the system. The identification information of the biometric reader can also include a specific Internet Protocol (IP) address of the biometric reader. The serial number and/or IP address can be used to authenticate the biometric reader and/or its location.

[0029] The override data flag is set when biometric data obtained from a member when services are provided does not match initially obtained biometric data. The override data is data input by a user at the service facility explaining why biometric data obtained from a member when services are provided does not match initially obtained biometric data of a member, i.e., why the override data flag is set.

[0030] Input device(s) 114 can include one or more common input devices including a keyboard, a mouse, a touch screen, etc. Output device(s) 1 15 can include one or more common output devices including a display, printer, speaker, etc.

[0031] Server computer 102 includes processor 121 , memory 123, input device(s) 124 and output device(s) 125. Processor 121 is a specialty processor programmed to control the operation of server computer 102.

[0032] Memory 123 is configured to store biometric data, member data, first and second data, override data flag(s), override data, reason data, scheduling data, service facility data, billing data, attendance data, and/or payor data as needed. Memory 123 is also configured to store programs for use by processor 121 to control the overall operation of server computer 102.

[0033] The member data stored in memory 123 of server computer 102 can include a member name, member identification numbers including social security numbers, electronic signature information, gender, address(es), phone number(s), etc., and can be modified and added to as needed. The member data is also stored associated with the first and second data, the override data flag(s), the override data, reason data, scheduling data, service facility data, and/or payor data related to the member.

[0034] The reason data is data received from a service provider explaining why override data in response to the override data flag(s) was required due to the non-match of the biometric data with member biometric data, i.e. an explanation to confirm attendance for the service(s) provided. Processor 121 is programmed to provide an alert to a payor and/or service provider when reason data is input and also provide the reason data itself. In this manner the payor and/or service provider can monitor the operations of service facilities that are providing services the payor is obligated to pay and the service provider is obligated to provide, and in turn discover and/or prevent any fraudulent payments.

[0035] The scheduling data is data related to the services provided by the service providers. These services can include service actually provided for at a physical location or other services, for example, transportation to and from the service facility. Other services are contemplated. The scheduling data can also include the actual times the services are to be provided. For example, a member needs transportation to and from a service facility to receive services for social interaction and occupational therapy. Scheduling data would include transportation pick-up time, start and end times for the social interaction, start and end times for the occupational therapy, and transportation leave time. This information can be entered by the service provider and/or the payor depending on individual requirements.

[0036] The service facility data can include names, addresses, identification numbers, staff, phone number(s), service type(s), etc., of each of the service providers associated with the members to which they provide services.

[0037] The payor data can include names, addresses, identification numbers, phone number(s), billing code(s), etc., of each of the payor companies associated with the members to which they pay for services.

[0038] The billing data can include prices, past invoice(s), voided invoice(s), and is cross-referenced with the attendance data. [0039] Input device(s) 124 can include one or more common input devices including a keyboard, a mouse, a touch screen, etc. Output device(s) 125 can include one or more common output devices including a display, printer, speaker, etc.

[0040] Service provider computer 103 includes processor 131 , memory 133, input device(s) 134 and output device(s) 135. Processor 131 is a specialty processor programmed to control the operation of service provider computer 103.

[0041] Memory 133 is configured to store data as needed. Memory 133 is also configured to store programs for use by processor 131 to control the overall operation of service provider computer 103.

[0042] The reason data is data provided to server computer 102 from the service provider through service provider computer 103 explaining why the override flag(s) were set and/or why the override data was input due to the non-match of the biometric data with member biometric data. Processor 131 is programmed to provide an alert and/or a display to a service provider when override data is included in the first and/or second data. In this manner the service provider can monitor the operations at the facilities which are providing services, and in turn discover and/or prevent any fraudulent data entries.

[0043] The scheduling data and the service facility data can be provided from service provider computer 103.

[0044] Input device(s) 134 can include one or more common input devices including a keyboard, a mouse, a touch screen, etc. Output device(s) 135 can include one or more common output devices including a display, printer, speaker, etc.

[0045] Payor computer 104 includes processor 141 , memory 143, input device(s) 144 and output device(s) 145. Processor 141 is a specialty processor programmed to control the operation of payor computer 104.

[0046] Memory 143 is configured to store data as needed. Memory 143 is also configured to store programs for use by processor 141 to control the overall operation of payor computer 104.

[0047] The reason data, override data flag(s), and/or override data can be provided from server computer 102 to payor computer 104. Processor 141 is programmed to provide an alert and/or a display to a payor when override data is included in the first and/or second data. In this manner the payor can monitor the operations at the facilities for the services they are paying for, and in turn discover and/or prevent any fraudulent data entries.

[0048] The scheduling data and the payor data can be provided from payor computer 104 and stored in memory 123 of server computer 102.

[0049] Input device(s) 144 can include one or more common input devices including a keyboard, a mouse, a touch screen, etc. Output device(s) 145 can include one or more common output devices including a display, printer, speaker, etc.

[0050] A biometric authentication fraud prevention method of system 100 will now be described. In step s1 member biometric data of at least one member is obtained from a biometric reader and stored in memory 113 with member data. In step s2 first biometric data of a person is obtained from the biometric reader at a check-in time the person arrives at a facility for services. In step s3 processor 111 compares the first biometric data with the member biometric data to determine if the first biometric data matches the member biometric data. Processor 111 compares the first biometric data with all of the stored member biometric data to determine if a match exists. If the first biometric data matches the member biometric data, in step s4 as first data the member data, a first time indicating when the first biometric data was obtained, and identification information of the biometric reader is transmit over network 105 to processor 121. If the first biometric data does not match the member biometric data, an override data flag is set for override data to be input by a user, and then as the first data the override data flag, a first time indicating when the override data flag was set, and the identification information of the biometric reader is transmit over network 105 to processor 121. The first data is stored in memory 123.

[0051] In step s6 if the override data flag was set the first data processor 121 causes an alert (visually or audibly) at either or both of service provider computer 103 and payor computer 104. At some point in time the override data itself is input by a user at the service facility explaining why the override data flag was set.

[0052] In step s7 server computer 102 determines if a request for a bill is received from service provider computer 103. If a bill is requested in step s8 processor 121 determines if an override data flag was set for the services and if so indicates that a reason for the override data should be input by a user. The reason should take into account the override data if entered and if not entered should explain why. The reason is stored as reason data in memory 132 associated with the first and second data and the member data.

[0053] In step s9 if the reason data was included the first data processor 121 causes an alert (visually or audibly) at either or both of service provider computer 103 and payor computer 104. Processor 121 can also display any combination of the override data flag(s), the override data and/or the reason data on a display of service provider computer 103 or a display of payor computer 104.

[0054] In step s10 second biometric data of a person is obtained from the biometric reader at a check-out time the person leaves the facility for the services. In step s1 authentication computer 101 compares the second biometric data with the member biometric data to determine if the second biometric data matches the member biometric data. In step s12 if the second biometric data matches the member biometric data, authentication computer 101 transmits over network 105 to server computer 102 as second data the member data, a second time indicating when the second biometric data was obtained, and the identification information of the biometric reader. In step s13 if the second biometric data does not match the member biometric data, a second override data flag is set for override data to be input by a user, and authentication computer 101 transmits over network 105 to server computer 102 as the second data the second override data flag, a second time indicating when the override data flag was set, and the identification information of the biometric reader. The second data is stored in memory 123.

[0055] In step s14 if the reason data was included the second data processor 121 causes an alert (visually or audibly) at either or both of service provider computer 103 and payor computer 104. Processor 121 can also display any combination of the override data flag(s), the override data and/or the reason data on a display of service provider computer 103 or a display of payor computer 104.

[0056] In step s15 server computer 102 determines if a request for a bill is received from service provider computer 103. If a bill is requested in step s16 processor 121 determines if an override data flag is set and/or if override data exists in either the first or second data for the services and if so requires a reason for the override data flag and/or the override data to be input by a user. The reason is stored as reason data in memory 132 associated with the first and second data and the member data.

[0057] In step s17 if the reason data was included the first data processor 121 causes an alert (visually or audibly) at either or both of service provider computer 103 and payor computer 104. Processor 121 can also display any combination of the override data flag(s), the override data and/or the reason data on a display of service provider computer 103 or a display of payor computer 104.

[0058] In step s18 server computer 102 compares the first data with the second data to determine an elapsed time between the first time and the second time. In step s19 server computer 102 compares the elapsed time with a pre-stored service time, and in step s20 provides an alert if the elapsed time does not match the pre-stored service time. The alert can be a visual or audible alert at either or both of service provider computer 103 and payor computer 104.

[0059] In step s21 server computer 102 can compare the first data with the second data to determine in step s22 if the identification information of the biometric reader of the first data matches the identification information of the biometric reader of the second data, and in step s23 provides an alert if the identification information of the biometric reader of the first data does not match the identification information of the biometric reader of the second data. The alert can be a visual or audible alert at either or both of service provider computer 103 and payor computer 104.

[0060] It is also noted that at time the biometric data is obtained (i.e. the initial biometric data, the check-in biometric data and/or the check-out biometric data) an electronic or standard signature can be required to be obtained from the member as a further layer of fraud prevention.

[0061] The present disclosure has been described herein in connection with day care facilities. Other applications are contemplated, for example, child care facilities, health care facilities, etc.

[0062] Where this application has listed the steps of a method or procedure in a specific order, it may be possible, or even expedient in certain circumstances, to change the order in which some steps are performed, and it is intended that the particular steps of the method or procedure claim set forth herebelow not be construed as being order- specific unless such order specificity is expressly stated in the claim.

[0063] While the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. Modification or combinations of the above-described assemblies, other embodiments, configurations, and methods for carrying out the invention, and variations of aspects of the invention that are obvious to those of skill in the art are intended to be within the scope of the claims.