Patent Number: 6,253,186

Title: Method and apparatus for detecting fraud

Abstract: A computerized arrangement for detecting potentially fraudulent suppliers or providers of goods or services includes a processor, a storage device, an input device for communicating data to the processor and storage device, and an output device for communicating data from the processor and storage device. The storage device includes a claims data file for storing information relating to a plurality of claims submitted for payment by a selected supplier or provider, one or more encoding lookup tables for use with the claims data file to produce an encoded claims data file, and a neural network program for analyzing the encoded data to produce an indicator of potentially fraudulent activity. The indicator may be compared to a predetermined threshold value by the apparatus or method to identify fraudulent suppliers. In addition to the neural network, at least one expert system may be used in the identification process.

Inventors: Pendleton, Jr.; E. Steele (Blythewood, SC)

Assignee: Blue Cross Blue Shield of South Carolina

International Classification: G06Q 40/00 (20060101); G06Q 10/00 (20060101); G06F 017/60 ()

Expiration Date: 06/26/2018