# US 2019/0244706 A1 · Device for reducing fraud, waste, and abuse in the ordering and performance of medical testing and methods for using the same > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2019/0244706 A1 - Document ID: US20190244706A1 - Status: Published application - Kind: A1 - Application number: 15/888,721 - Filed: 2018-02-05 - Published: 2019-08-08 - Earliest claimed: 2018-02-05 - Assignees: Optum, Inc. - Applicants: Optum, Inc. - Inventors: John L. WILSON; François CHARETTE - Web page: https://patentgrep.com/patent/US20190244706A1 ## CPC - G16H 40/20: for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms - G16H 10/40: for data related to laboratory analysis, e.g. patient specimen analysis - G16H 10/60: for patient-specific data, e.g. for electronic patient records - G16H 70/20: relating to practices or guidelines - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract Provided is a lab clearinghouse device configured to reduce fraud, waste, and abuse in the ordering and performance of medical testing. The lab clearinghouse device is configured to communicate with a plurality of medical laboratories, medical providers, and lab payers to efficiently and effectively reduce fraud, waste, and abuse in the ordering and performance of medical testing. ## Claims ### Claim 1 A device for reducing fraud, waste, and abuse in the ordering and performance of medical tests across a plurality of medical laboratories, medical providers, and lab payers, the device comprising a processor and a memory storing computer instructions that, when executed by the processor, cause the device to: receive a lab request from a lab request initiator, the lab request initiator being associated with at least one medical provider of the plurality of medical providers, wherein the lab request comprises an order for one or more medical tests to be performed; determine whether at least one of fraud, waste, or abuse in the lab request is likely by determining whether the lab request aligns with pre-established data associated with the lab request, wherein the pre-established data associated with the lab request includes patient data, physician data, provider data, lab data, payer data, or a combination thereof; approve or deny the lab request based on the determination of whether at least one of fraud, waste, or abuse in the lab request is likely, wherein approving the lab request comprises: generating lab instructions associated with the lab request after determining whether at least one of fraud, waste, or abuse in the lab request is likely, and transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of one or more corresponding medical tests, and wherein denying the lab request comprises transmitting a lab request denial to the lab request initiator, the lab request denial indicating that the lab request needs to be revised. ### Claim 2 (depends on 1) The device of claim 1, wherein the pre-established data associated with the lab request includes medical history of a patient associated with the lab request, wherein the medical history of the patient includes medical tests requested by a plurality of different providers. ### Claim 3 (depends on 1) The device of claim 1, wherein the pre-established data associated with the lab request forms a pre-established practice regarding ordering of lab requests by the plurality of medical providers. ### Claim 4 (depends on 1) The device of claim 1, wherein the pre-established data associated with the lab request includes persistent patient data associated with the lab request. ### Claim 5 (depends on 1) The device of claim 1, wherein when determining whether at least one of fraud, waste, or abuse in the lab request is likely, the computer instructions, when executed by the processor, cause the device to transmit a warning indication to a patient device associated with at least one of the plurality of patients, the warning indication configured to indicate that fraud, waste, abuse, or a combination thereof is suspected based on the determination of whether at least one of fraud, waste, or abuse in the lab request is likely. ### Claim 6 (depends on 5) The device of claim 5, wherein the computer instructions, when executed by the processor, cause the warning indication to be transmitted prior to generating lab instructions associated with the lab request and transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of the lab instructions. ### Claim 7 (depends on 1) The device of claim 1, wherein when determining whether at least one of fraud, waste, or abuse in the lab request is likely, the computer instructions, when executed by the processor, cause the device to transmit a request for additional patient data, physician data, provider data, lab data, payer data, or a combination thereof to one or more external devices operated by one or more of the plurality of medical laboratories, medical providers, lab payers, or a combination thereof. ### Claim 8 (depends on 1) The device of claim 1, wherein the computer instructions, when executed by the processor, further cause the device to transmit a lab fee indication to one lab payer of the plurality of lab payers prior to generating lab instructions associated with the lab request and transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of the lab instructions. ### Claim 9 (depends on 1) The device of claim 1, wherein the lab request denial comprises a suggested revised lab request, the suggested revised lab request comprises at least one of a suggested revised medical laboratory, suggested revised medical test, or a combination thereof. ### Claim 10 (depends on 1) The device of claim 1, wherein the computer instructions, when executed by the processor, further cause the device to receive a lab payment from at least one lab payer of the plurality of lab payers prior to generating lab instructions associated with the lab request. ### Claim 11 (depends on 10) The device of claim 10, wherein the computer instructions, when executed by the processor, further cause the device to receive lab results from the at least one laboratory of the plurality of medical laboratories and transmit at least part of the lab payment to the at least one laboratory of the plurality of medical laboratories. ### Claim 12 (depends on 11) The device of claim 11, wherein the computer instructions, when executed by the processor, further cause the device to transmit the lab results to the lab request initiator. ### Claim 13 A method of reducing fraud, waste, and abuse in the ordering and performance of medical testing across a plurality of patients, medical laboratories, medical providers, and lab payers, the method comprising: receiving, by a fraud, waste, and abuse circuitry, a lab request from a lab request initiator, the lab request initiator being associated with at least one medical provider of the plurality of medical providers, wherein the lab request comprises an order for one or more medical tests to be performed; determining, by an analytical engine, whether at least one of fraud, waste, or abuse in the lab request is likely by determining whether the lab request aligns with pre-established data associated with the lab request, wherein the pre-established data associated with the lab request includes patient data, physician data, provider data, lab data, payer data, or a combination thereof; approving or denying the lab request based on the determination of whether at least one of fraud, waste, or abuse in the lab request is likely, wherein approving the lab request comprises: generating, by the analytical engine, lab instructions associated with the lab request after determining whether at least one of fraud, waste, or abuse in the lab request is likely, and transmitting, by a communications interface, the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of one or more corresponding medical tests, and wherein denying the lab request comprises transmitting, by the communications interface, a lab request denial to the lab request initiator, the lab request denial indicating that the lab request needs to be revised. ### Claim 14 (depends on 13) The method of claim 13, wherein the pre-established data associated with the lab request includes medical history of a patient associated with the lab request, wherein the medical history of the patient includes medical tests requested by a plurality of different providers. ### Claim 15 (depends on 13) The method of claim 13, wherein the pre-established data associated with the lab request forms a pre-established practice regarding ordering of lab requests by the plurality of medical providers. ### Claim 16 (depends on 13) The method of claim 13, when determining whether fraud, waste, or abuse are likely comprises generating, by the analytical engine, and transmitting, by the communications interface, a warning indication to a patient device associated with at least one of the plurality of patients, the warning indication configured to indicate that fraud, waste, abuse, or a combination thereof is suspected. ### Claim 17 (depends on 16) The method of claim 16, wherein generating and transmitting the warning indication occurs prior to generating lab instructions associated with the lab request and transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of the lab instructions. ### Claim 18 (depends on 13) The method of claim 13, wherein the lab request denial comprises a suggested revised lab request, the suggested revised lab request comprises at least one of a suggested revised medical laboratory, suggested revised medical test, or a combination thereof. ### Claim 19 (depends on 13) The method of claim 13, wherein determining whether fraud, waste, or abuse are likely comprises transmitting, by the communications interface, a request for additional patient data, physician data, provider data, lab data, payer data, or a combination thereof to one or more external devices operated by one or more of the plurality of medical laboratories, medical providers, lab payers, or a combination thereof. ### Claim 20 A computer program product is provided comprising a non-transitory computer readable medium having computer program instructions stored therein, said computer program instructions, when executed by a processor, reduce fraud, waste, and abuse in the ordering and performance of medical testing across a plurality of patients, medical laboratories, medical providers, and lab payers, by causing the computer program product to: receive a lab request from a lab request initiator, the lab request initiator being associated with at least one medical provider of the plurality of medical providers, wherein the lab request comprises an order for one or more medical tests to be performed; determine whether fraud, waste, or abuse are likely by determining whether the lab request aligns with pre-established data associated with the lab request, wherein the pre-established data associated with the lab request includes patient data, physician data, provider data, lab data, payer data, or a combination thereof; approve or deny the lab request based on the determination of whether fraud, waste, or abuse are likely, wherein approving the lab request comprises: generating lab instructions associated with the lab request after determining whether at least one of fraud, waste, or abuse in the lab request is likely, and transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of the lab instructions, and wherein denying the lab request comprises transmitting a lab request denial to the lab request initiator to revise the lab request, the lab request denial indicating that the lab request needs to be revised.