AI Provider Authentication Using Risk-Based Fraud Scoring

Resolve Bottlenecks,
Find Innovative Solutions
Generate Solutions

Solution Overview

Problem

Existing authentication systems are vulnerable to unauthorized access and fraud, leading to system bottlenecks and inefficiencies, and lack comprehensive verification methods for service providers, particularly in healthcare claims processing.

Innovation Solution

An AI-based system for authenticating resource systems that integrates fraud detection and mitigation measures, utilizing machine learning models to analyze multiple data sources, perform down-sampling, and generate risk scores for service providers, enabling automated document verification and recommendation of verification levels.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If manual processing of authentication requests is implemented, then security verification can be performed, but system bottlenecks and processing delays occur

Engineering Contradiction:
Improveauthentication securityVSAvoidrequest processing speed
Core Design Contradiction:
ReliabilityVSProductivity

Solution Approach 1:

The patent replaces manual mechanical authentication processing with an automated machine learning-based system. The ML model analyzes provider data, performs risk assessments, and generates verification recommendations automatically, eliminating the need for manual review while maintaining security standards. This substitution resolves the contradiction by providing both security and high processing speed.

Inventive Principle:
Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The system enables self-service authentication where the ML model autonomously evaluates provider requests, determines risk levels, and generates verification recommendations without human intervention. The system serves itself by automatically processing authentication requests through trained algorithms, achieving both security and efficiency simultaneously.

Inventive Principle:
Principle #25Self-service

2Reliability

If comprehensive authentication measures are applied to all providers, then security is improved, but legitimate providers are unduly burdened

Engineering Contradiction:
Improvesecurity verificationVSAvoidprovider authentication process
Core Design Contradiction:
ReliabilityVSEase of operation

Solution Approach 1:

The patent applies different levels of authentication scrutiny to different providers based on their risk profiles. The ML model identifies high-risk providers requiring comprehensive verification while allowing low-risk legitimate providers to undergo streamlined authentication. This localized approach to security measures resolves the contradiction by tailoring verification intensity to individual provider characteristics rather than applying uniform measures to all.

Inventive Principle:
Principle #3Local quality

Solution Approach 2:

The system performs partial authentication for low-risk providers and comprehensive authentication for high-risk providers. Rather than applying excessive verification to all providers, the ML model determines the appropriate level of scrutiny for each case, performing only the necessary amount of verification required for each provider's risk level.

Inventive Principle:
Principle #16Partial or excessive action

3Productivity

If automated machine learning authentication is implemented, then processing efficiency is improved, but system complexity increases

Engineering Contradiction:
Improveauthentication processing speedVSAvoidsystem architecture
Core Design Contradiction:
ProductivityVSDevice complexity

Solution Approach 1:

The patent segments the authentication system into distinct functional modules: data collection, ML model processing, risk assessment, and verification recommendation generation. This modular segmentation manages system complexity by organizing the automated authentication process into manageable, independent components that can be developed, maintained, and scaled separately while maintaining high processing efficiency.

Inventive Principle:
Principle #1Segmentation

Data Source

PatentUS12603886B2Systems and methods for authenticating a resource system
Publication Date: 2026.04.14 UNITEDHEALTH GROUP INC
  • US12603886B2 patent drawing
  • US12603886B2 patent drawing
  • US12603886B2 patent drawing

AI summary

Systems and methods are disclosed for determining authenticity of a resource system. The method includes receiving a dataset that includes a first subset and a second subset associated with a first resource system; down-sampling the first subset but not the second subset; generating a first feature for a machine learning model based on the down-sampled first subset; generating a second feature for the machine learning model based on the second subset; generating, via input of at least one of the first feature or the second feature into the machine learning model that is trained to output a fraudulent measure, one or more data objects indicative of validating the fraudulent measure; and initiating performance of one or more prediction-based actions in response to the generating.