Abstract: A goods, services and payment authorization system and method are provided to prevent services from being rendered, goods from being provided and/or reimbursements from being made in the case of fraudulent healthcare transactions resulting from identity theft, phantom billing, lack of insurance coverage and/or medical fraud, in general. In conjunction with a healthcare transaction, patient identity information is collected and insurance coverage is confirmed using a programmatic calculation of a confidence determination based on the collected identity information.

Abstract: A system and method are provided for determining a probability of healthcare fraud and for providing a report identifying the determined probability to a Healthcare Provider or Payer. For example, the system verifies insurance eligibility using a presenting individual's insurance card and an officially issued government ID card (i.e., one for which the issuing Agency maintains an electronic photograph on file of the individual to whom the ID card was issued) and/or a biometric of the presenting individual. Additionally, data is collected from Electronic Medical Records, analyzed and packaged to identify possible fraud.