US 8,429,050 B2Granted

Method for detecting ineligibility of a beneficiary and system

OwnerMary Joan Willard, Allan Victor Burmaninventors

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Abstract

A method and system are presented for identifying improper benefit payments to an ineligible beneficiary. Record data may be accessed from a financial institution and may be analyzed to identify patterns within the banking transactions. Deviations may be identified between a pre-benefit pattern and a post-benefit pattern by applying one or more rules, which may be ranked. The deviations that are identified may be determined to be either in compliance, in noncompliance, or within some acceptable level of compliance. A level of noncompliance outside of a range of acceptable noncompliance may result in generating a request for an action to be taken, such as an audit of the beneficiary. The aforementioned methods may be carried out using a computerized device.

Claims19

Dependent claims

A method for determining beneficiary eligibility, the method comprising:

accessing record data from a financial institution relating to banking transactions of a potentially ineligible beneficiary;
analyzing the record data to determine a pattern of the banking transactions for a time period prior to receiving the benefit being defined as a pre-benefit pattern and for a time period following receiving the benefit being defined as a post-benefit pattern;
identifying deviations between the pre-benefit pattern and the post-benefit pattern;
applying a rule selected from a plurality of rules stored on a database to the deviations to determine a level of noncompliance of each of the deviations with the rule;
determining a level of overall noncompliance of the deviations by analyzing the level of noncompliance of each of the deviations;
determining if the level of overall noncompliance is within a range of acceptable noncompliance;
wherein each of the rules is assigned a predetermined rank according to its importance in determining overall noncompliance with respect to the other rules of the plurality of rules;
wherein compliance with the rule results in no action being taken;
wherein the level of overall noncompliance being within the range of acceptable noncompliance results in no action being taken;
wherein the level of overall noncompliance being outside the range of acceptable noncompliance results in determining if the level of overall noncompliance is above an audit threshold;
wherein the level of overall noncompliance being above the audit threshold results in auditing the record data relating to the beneficiary;
wherein the level of overall noncompliance being below the audit threshold results in communicating with the beneficiary;
wherein the request for the action to be taken is provided to a user using a user interface;
and
wherein accessing the record data, analyzing the record data, identifying the deviations between the pre-benefit pattern and the post-benefit pattern, applying the rule, determining the level of noncompliance, and determining if the level of noncompliance is within the range of acceptable noncompliance are carried out using a computerized device.

12 more elements

A method for determining beneficiary eligibility, the method comprising:

accessing record data from a financial institution relating to banking transactions of a potentially ineligible beneficiary;
analyzing the record data to determine a pattern of the banking transactions;
applying a rule selected from a plurality of rules stored on a database to the pattern;
determining a level of overall noncompliance of the pattern by analyzing the level of noncompliance of each of the banking transactions;
determining if the level of overall noncompliance is within a range of acceptable noncompliance;
wherein compliance with the rule results in no action being taken;
wherein the level of overall noncompliance being within the range of acceptable noncompliance results in no action being taken;
wherein the level of overall noncompliance being outside the range of acceptable noncompliance results in determining if the level of overall noncompliance is above an audit threshold;
wherein the level of overall noncompliance being above the audit threshold results in auditing the record data relating to the beneficiary;
wherein the level of overall noncompliance being below the audit threshold results in communicating with the beneficiary;
wherein the request for the action to be taken is provided to a user using a user interface;
wherein each of the rules is assigned a predetermined rank according to its importance in determining overall noncompliance with respect to the other rules of the plurality of rules;
wherein accessing the record data, analyzing the record data, applying the rule, determining the level of noncompliance, and determining if the level of overall noncompliance is within the range of acceptable noncompliance are carried out using a computerized device;
wherein the computerized device includes a network interface that connects to a network;
wherein analyzing the record data to determine the pattern of the banking transactions further comprises communicating with a banking computerized device through the network.

12 more elements

A system for determining beneficiary eligibility, the system comprising:

a network interface on a computerized device that connects to a network, the computerized device including a memory and a processor;
a banking computerized device in communication with the network;
and wherein record data from a financial institution relating to banking transactions of a potentially ineligible beneficiary is accessed using the computerized device;
wherein the record data is analyzed using the computerized device to determine a pattern of the banking transactions;
wherein a rule selected from a plurality of rules stored on a database is applied to the pattern of the banking transactions using the computerized device;
wherein a level of overall noncompliance of the pattern is determined using the computerized device by analyzing the level of noncompliance of each of the banking transactions;
wherein the level of overall noncompliance is determined to be within a range of acceptable noncompliance using the computerized device;
wherein compliance with the rule results in no action being taken;
wherein the level of overall noncompliance being within the range of acceptable noncompliance results in no action being taken;
wherein the level of overall noncompliance being outside the range of acceptable noncompliance results in determining if the level of overall noncompliance is above an audit threshold by the computerized device;
wherein the level of overall noncompliance being above the audit threshold results in auditing the record data relating to the beneficiary;
wherein the level of overall noncompliance being below the audit threshold results in communicating with the beneficiary;
wherein each of the rules is assigned a predetermined rank according to its importance in determining overall noncompliance with respect to the other rules of the plurality of rules;
and wherein the request for the action to be taken is provided to a user using a user interface.

11 more elements

Dependencies are inferred from the claim text.

Facts

Application: 13/281,531Filed 26 Oct 2011 · us provisional application
Priority: 1 Nov 2010
Published: US 2012/0109806 A13 May 2012
Granted: 23 Apr 2013
Term ends: Not estimatedThe source records don’t support an estimate.

Classification5 codes

G06Q 40/00
Finance
G06Q 10/10
Administration; Management: office automation; Time management
G06Q 40/02
Finance; Insurance; Tax strategies; Processing of corporate or income taxes: banking, e.g. interest calculation or account maintenance
G06Q 50/26
Services: government or public services