Predictive modeling processes for healthcare fraud detection

• Main Authors: Schweyen, Corrine L, Hagins, Scott, Mahone, Saralyn M, Van Arkel, John H, Curtis, Terrill J, Tada, David D, Wagner, James J
• Format: Patent
• Language: English
• Published: 17.12.2019
• Subjects: CALCULATING; COMPUTING; COUNTING; DATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FORADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORYOR FORECASTING PURPOSES; PHYSICS; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE,COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTINGPURPOSES, NOT OTHERWISE PROVIDED FOR

A device for using rules in the processing of information includes a first interface that allows for secure communications, a first database, a second database, a second interface that allows for secure communications, and a detection component implemented at least partially in hardware, the first interface connecting to the first database, the first database connecting to the detection component, the second database connecting to the detection component, the second interface connecting to the detection component, the second database including a plurality of rule libraries, each rule library, of the plurality of rule libraries, storing a set of related rules, and a plurality of rule engines, each rule engine, of the plurality of rule engines, corresponding to a rule library, of the plurality of libraries, and the detection component including a rule selector, and a rule applicator to apply a selected rule to information.