Method and card for accelerated provision of funds and fraud reduction for social services

Description of equivalent WO 2004049129 A2

TITLE:

METHOD AND CARD FOR ACCELERATED PROVISION

FUNDS AND FRAUD REDUCTION FOR SOCIAL SERVICES

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Patent Application Serial Nos. 10/303,191, filed November 25, 2002, 10/303,217, filed November 25, 2003 and 10/428,213, filed May 2, 2003, which are incorporated herein.

FIELD OF THE INVENTION

[0002] Embodiments of the present invention relate to methods for providing funds to a social service provider using a smart card that contains identification, security measures, and other information to facilitate the transfer o f funds and eliminate fraud in the social services. Embodiments of the present invention further relate to a method for reducing fraud in a government benefit program using a smart card that contains identification, security measures, and other information to facilitate the transfer of funds and eliminate fraud in the benefit.

BACKGROUND OF THE INVENTION

[0003] Providers of social services have traditionally had to wait long periods of time to get paid for their services. These providers have been required to extend credit to individuals in order to get paid. This situation has become tedious and causes social services costs to be very high.

[0004] A need has long existed for a system, wherein the government advances funds so that the individual does not have to handle money.

[0005] In view of the foregoing, there is a need for a more fully automated claims processing system that have the ability to have an accelerated pay schedule and an ability to reduce the uncertainty as to whether a claim to be submitted is likely to be paid or rejected. SUMMARY OF THE INVENTION

[0006] Embodiments of the invention relate to a method for accelerating the provision of funds to a service provider from social service using a smart card, comprising the steps of: obtaining social service for a individual; creating a smart card for the individual, wherein the smart card c omprises: information about social service for the individual and a individually identification code.

[0007] Next, the smart card is used to determine if the individual is eligible for accelerated provision of funds from the government to a service provider for social services based on coverage.

[0008] The smart card is used to determine if a social service is preauthorized by the government for the individual.

[0009] The smart card is used to determine if a service provider is preauthorized by the government to perform a social service. Once these determinations are made, the smart card facilitates a first transmission from the service provider to the government. The first transmission can include information relative to social service costs, information on the social services provided; and an acknowledgement that the social service has been rendered from the service provider to the individual.

[00010] The smart card facilitates the receipt of a second transmission from the government to the service provider. The second transmission preferably comprises the amount of payment r equired b y t he i ndividual. I n a ddition, t he s mart c ard facilitates a t hird transmission to the government from the service provider. This third transmission comprises an acknowledgement that the amount of payment required by the individual is based on the coverage, such as the co-payment or the deductible amount. On approximately the same day that the third transmission is received by the government, funds are transmitted from the government to the service provider for the social service provided to the individual. [00011] Embodiments of the invention further include a smart card for accelerating the provision of funds.

[00012] Further, embodiments of the invention include additional methods for reducing fraud.

BRIEF DESCRIPTION OF THE DRAWINGS

[00013] The present invention will be explained in greater detail with reference to the appended Figures, in which:

[00014] FIG 1 is a diagrammatic representation of an overall method of the invention;

[00015] FIG 2 is a diagrammatic representation of a first transmission;

[00016] FIG 3 is a diagrammatic representation of a second transmission;

[00017] FIG 4 is a diagrammatic representation of a third transmission;

[00018] FIG 5 is a diagram of a smart card usable in the invention;

[00019] FIG 6 is a picture of a smart card;

[00020] FIG 7 is a representation of information included in a microchip;

[00021] FIG 8 shows the service provider information stored in the smart card;

[00022] FIG 9 show coinsurance information stored in the microchip;

[00023] FIG 10 shows transmission codes stored in the smart card;

[00024] FIG 11 is a diagrammatic representation of another overall method of the invention;

[00025] FIG 12 is a diagrammatic representation of a first transmission;

[00026] FIG 13 is a diagrammatic representation of a second transmission; and [00027] FIG 14 is a diagrammatic representation of a third transmission.

[00028] The present invention is detailed below with reference to the listed Figures.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[00029] Before explaining the present invention in detail, it is to be understood that the invention is not limited to the particular embodiments and that it can be practiced or carried out in various ways.

[00030] One embodiment of the invention relates to a method for accelerating the provision of funds to a service provider from social service using a smart card. This means, the method relates to the provision of money, such as $75 for a social service using a plastic card. The plastic card can, in some embodiments, include a chip containing information on the individual. It is also contemplated that a plastic smart card could be used with a magnetic strip without a chip provided it has security codes or biometric reading ability affiliated with the magnetic strip.

[00031] The invention advantageously reduces fraud on social service companies and the government by providing a safe method of pre-authorizing users and guaranteeing payment from single or multiple sources.

[00032] The steps of this method include first obtaining social service for an individual.

[00033] Next, a smart card is created for the individual. For the chip version of the smart card, the card is first manufactured in a conventional manner, and then the relevant information is downloaded from the computers of the service provider to the card.

For a non-chip version o f a smart c ard, the c ard manufacturer would be provided information about the individual from the service provider and embed the relevant information in the magnetic strip and then mail or transfer the magnetic strip card to the user.

[00034] The individual can be the primary individual, a spouse, a non-married "significant partner", at least one dependent, such as one or more children, or it can be combinations of these.

[00035] The smart card can contain information about social service and an individual identification code, such as an individual identification number or "PIN".

[00036] The smart card is an electronically readable card and can connect to the service provider, and may be via the Internet or telephone line. The card is contemplated to preferably contain information on at least one or more of the following:

a. individual name (example - Richard Wood);

b. individual address (example - 2396 Wood Street, Houston, Texas 77019);

c. individual phone number (example - 713-323-5555);

d. individual fax number (example - 713-323-5554);

e. individual email address (example - Wood@aol.com);

f government name or plan manager name (example - a privately funded plan such as Klein Independent School District Employee Benefit Plan of Texas);

g. government address or plan manager's address (example - the address for the

Klein Plan PO Box 672528, Houston, Texas 77267);

h. go vernment phone number or plan manager's phone number (example - 281-873- 8682);

i. optionally, the government fax or plan manager's fax number;

j. optionally, government e-mail or plan manager's email address;

k. government's website or plan manager's website (example www.hasonline.com); 1. government claims representative or plan manager's representative (example - Health Administration Services, Inc.);

m. type of plan (example - PPO);

n. individual policy number or plan number (example - Group 200116289.);

o. individual group number or group plan number (example - KLINASD);

p. individual's co-pay amount (example -$25);

q. individual deductible amount (example - $500 deductible);

r. individual's social service history;

s. instructions (example - pre-certification instructions or urgent admission instructions or emergency admission instructions can be embedded in the card);

t. other phone numbers (example - a phone number for prescription information, a phone number to locate qualified pharmacies under the plan, a phone number to call an approved pharmacist, a phone number to talk to a government's nurse, a phone number for mental health questions, and/or a phone number for chemical dependency);

u. issue date or "validity" date;

v. an expiration date or "expiry date";

w. statements as to ownership of the card;

x. statements as to eligibility of the holder as to the rights of the card and the existence of written agreements related to the card; and

y. disclaimers concerning use, misuse and revocation of the card. [00037] The smart card can also contain information on funds which are available from the government for a completed authorized social service for a particular patient. For example, the card can contain information on the "accelerated fund payment schedule" or the typical payment schedule for a particular social service if the two differ. Generally, the phrase "completed authorized social service" is considered to be a service that has been authorized by contract by the government or is a stated item of coverage.

[00038] The accelerated fund payment schedule could be a 100% payment schedule or a partial accelerated fund payment schedule depending on the contract with the government. It is contemplated that the funds would move electronically from the government's bank account to the service provider's bank account, such as by wire transfer, or similar normal electronic banking procedures.

[00039] Additionally, the smart card can contain information about the various insurance coverages held by the individual. An individual can have insurance that could cover the costs of the social service.

[00040] In the method, the smart card is used to determine if the individual is eligible for accelerated provision of funds from the government to a service provider for social services based on coverage.

[00041] Additionally, the smart card can be used to determine if a social service is preauthorized by the government for the individual, such as for a "John Doe", who is preauthorized for all services without need for additional authorization from the government.

[00042] The smart card is used to not only contain the information described above, but to link to the government's database and between the government's database and the service provider's database and the service provider's bank account. The smart card facilitates a first transmission from the service provider to the government. This first transmission can include information on:

i. determination that the card is valid and the individual is eligible;

ii. determination that the service provider is authorized to provide the service;

iii. proposed social service costs;

iv. information on the social services ; and

v. an acknowledgement that at least one social service has been rendered from the service provider to the individual.

[00043] The smart card facilitates the receipt of a second transmission from the government to t he s ervice p rovider. T his s econd t ransmission c an c ontain i nformation o n t he amount of payment required by the individual based on the insurance coverage. The amount of payment can be all or part of a co-payment fee, all or part of a deductible fee and combinations of these fees.

[00044] The smart card facilitates a third transmission to the government from the service provider. This third transmission would include an acknowledgement that the amount of the co-payment and the deductible has been paid by the individual to the service provider thereby initiating payment by the government.

[00045] Additionally, the government, as a set in the process, must make contracts with various service providers, such as pharmacists, nurses, doctors, and nursing homes that can be linked to the smart card.

[00046] The method involves that on approximately the same day that the third transmission is received by the government, or perhaps on or a few days later, funds are then transmitted from the government to the service provider for the social service provided t o t he i ndividual. T his accelerated p ayment p Ian i s a v ast i mprovement over known systems that take up to eight months to pay a service provider.

[00047] This method contemplates that the social service can be service related to a health procedure. This can be an operation or an out-patient procedure. It can apply to prescription filing; social examinations, social tests, social diagnosis, eye glass prescriptions, dental examinations, dental procedures, mental health procedures, mental health therapies, physical therapy, podiatrists, doctor's visits, hospital visits, out-patient visits, and combinations of these and other procedures that have not been named.

[00048] This method contemplates that the smart card can be used to determine if a second opinion is required by the government for a social service.

[00049] Now and with reference to the Figures, FIG 1 shows a diagram of the overall invention.

[00050] First, a smart card is issued to an individual (100). The smart card is related to a particular non-health government social service program having an individual identification code for the individual. A relationship is created between the providers of services and products under the particular non-health government social service program (110). The providers of the service will be paid directly by the government.

[00051] The smart card is used to determine if the individual is the owner of the card (115) and is preauthorized for the advancement of funds (120) for a particular non-health government s ocial s ervice p rogram. T he s mart c ard i s n ext u sed t o e stablish i f a service provider is preauthorized to provide a product or service under the particular non-health government social service program (130).

[00052] The smart card is used using the smart card to facilitate a first transmission from the service provider to the program administrator (140). [00053] As shown in FIG 2, the first transmission includes service provider identification (210), individual identification (220), proposed product and service information (230), and a request to confirm (230). The confirmation involves the individual's eligibility for benefits under the particular non-health government social service program (240) and validation that accelerated payment of funds under the particular governmental program is available (250).

[00054] The first transmission (140) can further include a first transmission identification code (260); service provider information (270); and individual information (280). Examples of service provider information (270) are service provider code (272), service provider name (274), service provider address (276), service provider office code (278), and service provider phone number (279). Examples of individual information (280) are individual name (282), individual address (284), government phone (286), and individual social security number (288), and combinations thereof.

[00055] Referring back to FIG 1, the smart card is used to facilitate a second transmission from the government to the service provider (160).

[00056] As shown in FIG 3, the second transmission (160) includes confirmation of accelerated payment of funds under the particular governmental program (310); an optional alert to the service provider that a portion of the funds may need to come from the individual and an indication of that fund amount (320); dollar amount limits for the accelerated payment (330); contact individual at the program administrator's office (340); and an authorization code to provide the product and/or service and to guarantee payment for the rendered services (350).

[00057] The second transmission (160) can also include reference codes from the government to be used by the service provider to perform the services (355); a notice as to further services potentially needed by the individual (360); a depiction of the individual

(365); a second transmission identification code (370), and combinations thereof. [00058] Referring back to FIG 1 , the smart card, next, is used to facilitate a third transmission from the service provider to the government (180).

[00059] The third transmission (170), shown in FIG 4, involves an acknowledgement of the product and/or service cost (410); information on the product and/or service provided to the individual (420); acknowledgement that the product or service has been received b y t he i ndividual from t he s ervice p rovider ( 430); a nd a cknowledgement that funds if necessary, were collected from the individual by the service provider (440).

[00060] On approximately the same day that the third transmission is received by the government, funds are transmitted from the government to the service provider (180) for the product and/or service provided to the individual.

[00061] The third transmission (170) can also involve a tracking number (445); date social service was rendered (450); total amount charged to individual (455); statement as to amount that exceeds rendered social service (460); detail on reference codes for rendered social services (465); a third transmission identification code (470); and combinations thereof.

[00062] FIG 5 shows a front view of the smart card (200), while FIG 6 shows the back view of the smart card (200). Physically, the smart card (200) includes a card substrate and a microchip (220) embedded in the card substrate. As seen in FIG 5, the smart card also has a picture (2100) of the user along with design markings (207) identifying the card as a smart card (200), the name of the user and other common identifiers. These design markings (207) can be the mark of government social services provider, the mark of the service provider, and the mark of any third party. Examples of third parties includes a financial institution, a grocery store, a car rental agency, an airline, a office supply chain, a hotel chain, recreational company marks and combinations thereof. [00063] As seen in FIG 6, the back of the smart card (200) has a magnetic medium (240) and a place for the user to sign his name (245) so any signature can be verified.

[00064] The smart card (200) includes numerous security devices to protect the user. FIG 5 shows that the microchip (220) can include eye information (225), fingerprint information (230), and digital signature information (235). Electronic fingerprinting and fingerprint recognition is a currently believed secure method of identification. This is far more secure than PIN codes that can be obtained even when encrypted relatively easily. Social security numbers are generally not considered secure. It is necessary for the individual who owns the smart card to have unique identifiers to allow access to the information on the card. Using first a fingerprint encoding device, the fingerprint or fingerprints of the owner of the card are loaded onto the non re-writable portion of the card's chip. A fingerprint reader connected to the card reader matches the real time image of the fingerprint (s) to the stored image and then provides electronic verification that the card and its owner are together at the same time. The owner can then enter a PIN code or other security code that will allow access to the information on the card by the then approved reader. The owner's authorization allows information to be shared between approved parties.

[00065] In the same way the fingerprint devices and stored images can be used for matching, other verification and authorization recognition devices can be used as well. Laser or optical retinal scanning and facial recognition scanning use the same techniques with different equipment. First, the image of the retina of the owner's eye is scanned and recorded permanently onto the chip of the card in a non-changeable location and format. At the time of verification a scanner is used to scan the card owner's retina in real time and compare the recorded image to the real time one. If there is a match then the owner's identity is verified and they can proceed to provide other authorizations as above.

[00066] Facial recognition works in the same manner as retinal scanning as does several other forms of "optical" recognition and verification. The smart card (200) is contemplated to have all of these security measures.

[00067] The microchip (220) also has information about the government social services provider and individual. FIG 7 is representation of the information included on the microchip (220). The microchip (220) includes information pertaining directly to the individual. This individual information is the name (302), address (304), phone number (306), social security number (308), fax number (310), and e-mail address (312). The microchip (220) also has information about the government social services provider like the government social services provider name (314), government social services provider address (316), government social services provider phone number (318), government social services provider fax number

(320), government social services provider e-mail address (322), the government social services provider claims representative (324), and government social services provider website (354).

[00068] The microchip (220) also includes information that assists in accelerating the provision of funds to a service provider, as shown in FIG 7. The microchip (220) has the individual policy number (326); the individual group number (328); individual's co-pay amount (330); individual deductible amount (332); individual's medical history ( 334); and the individual type o f p lan ( 336). T he microchip also contains secondary information such as the individual pharmacy plan (338); pharmacist phone number (340); individual prescription history (342); and emergency care health conditions (346). The microchip (220) also includes other phone numbers (344), instructions on how to contact government social services provider (348), expiration date of card (350), and expiration date of policy (352), and any other combinations of the included information.

[00069] The microchip (220) can also have medical information, like medicinal prescriptions, for executing the medical transaction. The smart card (200) functions to communicate various types of information between government social services provider, individual, and other parties concerned in accelerating the provision of funds to a service provider. The functions of the smart card (200) include:

i. communicating one or more of the information items encoded on the microchip (220) and shown in FIG 7;

ii. verifying the individual is the owner of the smart card;

iii. communicating the individual's identification information to the government social services provider;

iv. communicating the individual's symptoms to the government social services provider;

v. communicating the service provider information to the government social services provider;

vi. communicating transmission codes;

vii. communicating claim codes for an individual;

viii. communicating deductible and co-payments required of individual;

ix. communicating individual's medical history to enable a service provider to evaluate a proposed treatment;

x. communicating the proposed treatment to an government social services provider;

xi. communicating the cost to be charged from the proposed treatment; xii. communicating from the government social services provider that the cost of proposed treatment fit within the guidelines of the government social services provider;

xiii. communicating authorization codes to perform the proposed treatment;

xiv. communicating notice from the service provider that additional service for the individual may be needed;

xv. communicating eligibility of a service provider for accelerated funds transfer;

xvi. communicating that the proposed treatment to the individual has been provided to the government social services provider;

xvii. communicating the deductible and co-payments were made by the individual to the service provider to the government social services provider;

xviii. communicating annual and ever-to-date government social services providers report to the individual;

xix. communicating complete medical history to the individual;

xx. communicating the status of payment to the service provider for the proposed treatment; and

xxi. communicating combinations thereof.

As listed above, one of the functions of the smart card (200) is to communicate the service provider information to the government social services provider. FIG 8 shows the service provider information stored in the smart card (200). The information found on the microchip (220) includes service provider name (410); service provider code (420); service provider address (430); service provider phone number (440); service provider office code (450); service provider's diagnosis (460); service provider's treatment (470); and service provider's prognosis (480).

[00072] FIG 9 is a diagrammatic representation of the co-insurance information stored in the microchip (220) on the smart card (200). The insurance information is the name of co-government social services provider (5100), the policy number of co-government social services provider (5200), the amount of funds to be paid by co-government social services provider (5300), and combinations thereof.

[00073] FIG 10 shows the transmission codes stored in the smart card (200). The transmission codes are also located on the microchip (220). The transmission codes are for medical history diagnosis (6100), treatment (6200), prognosis (6300), and combinations of a medical history (6400). Other transmission codes are for insurance payment histories. These codes are for histories from government social services provider payments (6500), from government social services provider co-pay payments (6600), from individual deductible amounts (6700), from additional government social services providers (6800), and for combined insurance payment histories (690).

[00074] The smart card (200) itself can further have a magnetic medium (240) on the card substrate. Both the microchip (220) and the magnetic medium (240) can contain all or a portion of the information.

[00075] In an alternative embodiment, the smart card (200) is a magnetic readable card for accelerating the provision of funds to a service provider with a card substrate and a magnetic medium on the card substrate.

[00076] The method described herein is its preferred embodiment is a direct transaction between the service provider and the government using the smart card to facilitate the transaction. In an alternative embodiment, the smart card is contemplated to provide aid to third parties intermediaries. [00077] These third party intermediaries act as a go between the government programs and the individuals receiving the benefit from a government program. Examples of third party intermediaries are School for Meal programs, job placement assistance programs, organizations like Meals On Wheels, and other similar programs.

[00078] The smart card would facilitate access to the funds the government gives to the third party intermediaries. The funds in the third party intermediaries' account would be transferred directly to the service provider once government approved services had been rendered.

[00079] The smart card would also enable the third party intermediaries to report in a more expedited manner without additional labor. The government presently requires regular reports, both on an individual basis and in aggregate, in order for the third party intermediaries to receive funds. Using the smart card eliminates the need for the third party intermediaries to create the reports because the smart card tracks and reports automatically.

[00080] The invention advantageously reduces fraud on the government by providing a safe method of pre-authorizing users for benefits prior to rendering the benefit.

[00081] The invention also advantageously avoids ineligible users from using services for which they are not authorized. The invention safe guards the government from users attempting to apply for the same service more than once, in other words "double dipping".

[00082] FIG 11 shows a diagram of another method of the invention.

[00083] First, a service provider is registered with a governmental agency (1000) and the service provider is given an identification code (1100). Next, at least one service or good of the service provider is registered with the governmental agency (1200) and a claim code is given for the registered service or good (1300). [00084] The smart card is, then, used to determine if the individual is the authorized bearer of the c ard ( 1400) a nd i f t he i ndividual i s e ligible for t he b enefit o f t he government benefit program (1500).

[00085] The smart card is used to facilitate a first transmission from the service provider to a program administrator (1700) for a government agency.

[00086] As shown in FIG 12, the first transmission (1700) includes service provider identification (2100), individual identification code (2200), proposed information (2300), and a request to confirm (2400). The proposed information (2300) involves proposed product information for the individual (2320), proposed service information for the individual (2340), corresponding claim codes for the proposed product (23600), and corresponding claim codes for the proposed service (2380). The request to confirm (2400) entails validation that individual's eligibility for benefits (2420), the proposed good/service is approved for the individual (2440), service provider's eligibility to provide good/service (2460), and request to participate in an accelerated payment program (2480).

[00087] The first transmission (1700) can further include a first transmission identification code (2600); service provider information (2700); and individual information (2800). Examples of service provider information (2700) are service provider code (2720), service provider name (2740), service provider address (2760), service provider office code (2780), and service provider phone number (2790). Examples of individual information (2800) are individual name (2820), individual address (2840), government phone (2860), and individual social security number (2880), and combinations of these.

[00088] Referring back to FIG 11, the smart card is used to facilitate a second transmission from the government to the service provider (1800).

[00089] As shown in FIG 13, the second transmission (1800) includes individual's eligibility for benefits under the government benefit program (3100), validation that the proposed good or proposed service is approved for the individual (3200), validation of the service provider's eligibility to render services under the government benefit program (3300), confirmation that an accelerated payment program is available (3400), and authorization code to provide the proposed product and/or proposed service (3500).

[00090] The second transmission (1800) can also include notice as to further goods/services potentially needed by the individual (3600), depiction of the individual (3700), a second transmission identification code (3800), and combinations thereof.

[00091] Referring back to FIG 11, the smart card, next, is used to facilitate a third transmission from the service provider to the government ( 1900).

[00092] The third transmission (1900), shown in FIG 4, involves list of claim codes for services rendered (4100), acknowledgement by the individual that information on the product and/or service was provided to the individual (4200), acknowledgement that the product or service has been received from the service provider (4300), and request for accelerated payment by the governmental agency to the service provider

(4400).

[00093] On approximately the same day that the third transmission is received by the government, funds are transmitted from the government to the service provider (1800) for the product and/or service provided to the individual.

[00094] The third transmission (1900) can also involve a tracking number (4450); date benefit was rendered (4500); total amount charged to individual (4550); statement as to amount that exceeds rendered benefit (4600); detail on reference codes for rendered benefit (4650); a third transmission identification code (4700); and combinations thereof.

[00095] FIG 15 shows a smart card that is contemplated as within the scope of the invention. The smart card is an electronically readable card containing individual name (5020); individual address (5040); individual phone number (5060); individual fax number (5080); individual email address (5100); individual social security number (5120); government benefit program name (5140); government benefit program address (5160); government phone number (5180); government fax number (5200); government e-mail address (5220); government benefit program administrator

(5240); description of benefit plan (5260); optional individual payment amount (5280); individual's benefit history (5300) (this information can include information on length of time on government programs and types of other programs the individual is a participant); other phone numbers (5320); instructions on how to contact g overnment (5340); e xpiration d ate o f t he c ard (5360); g overnment w ebsite

(5380); a chip to link to the government for information on the benefit program (5400); and combinations thereof. Examples of each information type are located earlier in this description.

[00096] In alternative embodiments, the method can include the step of creating a contractual relationship between the government and a third party for the benefit of the individual. The method can also include the step of disposing marks on the card.

Examples of marks on the card are the government, third parties, service providers and combinations thereof.

[00097] The funds can be for a completed authorized benefit. A completed authorized benefit is a service that has been authorized by contract by the government or is a stated item of coverage in a government benefit plan.

[00098] The smart card is used for the retirement agency program and at least one other government program requiring identification. Examples of other government programs requiring identification are Passport Agencies, Immigration and Naturalization Service, Internal Revenue Service, state driver's licensure agencies, state parks, federal parks, federal monuments, and other similar agencies and organizations

[00099] Also, in any of the discussed methods, the smart card is contemplated to be used for more than one government benefit program or retirement agency program.

While this invention has been described with emphasis on the preferred embodiments, it should be understood that within the scope of the appended claims the invention might be practiced other than as specifically described herein.