Prosecution Insights
Last updated: July 17, 2026
Application No. 19/022,202

SYSTEMS AND METHODS FOR MEDICAL FRAUD DETECTION

Non-Final OA §101§DP
Filed
Jan 15, 2025
Priority
May 03, 2023 — continuation of 12/236,490
Examiner
NGUYEN, TIEN C
Art Unit
Tech Center
Assignee
UnitedHealth Group Incorporated
OA Round
1 (Non-Final)
68%
Grant Probability
Favorable
1-2
OA Rounds
1y 4m
Est. Remaining
86%
With Interview

Examiner Intelligence

Grants 68% — above average
68%
Career Allowance Rate
447 granted / 659 resolved
+7.8% vs TC avg
Strong +18% interview lift
Without
With
+18.2%
Interview Lift
resolved cases with interview
Typical timeline
2y 10m
Avg Prosecution
28 currently pending
Career history
685
Total Applications
across all art units

Statute-Specific Performance

§101
38.9%
-1.1% vs TC avg
§103
34.9%
-5.1% vs TC avg
§102
4.6%
-35.4% vs TC avg
§112
3.4%
-36.6% vs TC avg
Black line = Tech Center average estimate • Based on career data from 659 resolved cases

Office Action

§101 §DP
Notice of Pre-AIA or AIA Status The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA . DETAILED ACTION Status of the Claims The following office action in response to the application filed on 01/15/2025. Claims 1-20 were previously presented. Therefore, claims 1-20 are pending and addressed below. Claim Rejections - 35 USC § 101 35 U.S.C. 101 reads as follows: Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title. Claims 1-20 are rejected under 35 U.S.C. 101 because the claimed invention is directed to non-statutory subject matter. Claims 1-20 are directed to a method, a system, a non-transitory computer readable medium which is a process, machine, manufacturer or composition of matter and thus statutory category of invention (Step 1: YES). Claim 1 is rejected under 35 U.S.C. 101 because the claimed invention recites an abstract idea without significantly more. The claim recites “…receiving one or more resource requests associated with a target entity; generating a first graph based on first characteristics data associated with one or more known fraudulent entities, wherein the first graph includes one or more first nodes that respectively represent the one or more known fraudulent entities; generating a second graph based on second characteristics data associated with the target entity, wherein the second graph includes a second node that represents the target entity; generating an association score for the target entity by measuring a degree of association between the first graph and the second graph; determining whether the target entity is an investigative target based on the association score; and generating and upon determining that the target entity is the investigative target, computer-executable instructions to invalidate the one or more resource requests associated with the target entity. These recited limitations, as drafted, is a process that, under its broadest reasonable interpretation, covers performance of fundamental economic principles or practices (including mitigating risk; determining and detecting target fraudulent entities) but for the recitation of generic computer components. If a claim limitation, under its broadest reasonable interpretation, covers performance of fundamental economic principles or practices but for the recitation of generic computer components, then it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea. The additional limitations (besides those that recite the abstract idea) include the presence in the method claim of one or more processors that are recited at a high level of generality to perform the functions of “receiving … one or more resource requests…; generating …a first graph based on first characteristics data …; generating… a second graph based on second characteristics data …; generating…an association score for the target entity by measuring… a degree of association between the first graph and the second graph; determining… whether the target entity is an investigative target…; and generating…computer-executable instructions to invalidate the one or more resource requests…”, such that it amounts no more than mere instructions to apply the exception using the generic computer component. Accordingly, the additional elements do not integrate the abstract idea into a particular application because it does not impose any meaningful limits on practicing the abstract idea. The claim is directed to an abstract idea. The claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception or amount to an inventive concept. As discussed above with respect to integration of the abstract idea into a practical application, the additional limitations of the one or more processors that are recited at a high level of generality to perform the functions of “receiving … one or more resource requests…; generating …a first graph based on first characteristics data …; generating… a second graph based on second characteristics data …; generating…an association score for the target entity by measuring… a degree of association between the first graph and the second graph; determining… whether the target entity is an investigative target…; and generating…computer-executable instructions to invalidate the one or more resource requests…”, above amounts to mere instructions to apply the exception using the generic computer component. When viewing the additional elements either individually or as an ordered combination, the claim as a whole does not amount to significantly more than the judicial exception because the claim does not include improvements to another technology or technical field, improvements to the function of the computer itself, and does not provide meaningful limitations beyond general linking the use of an abstract idea to a particular technological environment. In effect, the additional limitations add the words “apply it” (or an equivalent) to the judicial exception, or mere instructions to implement an abstract idea on a computer. Mere instructions to apply an exception using the generic computer component cannot provide an inventive concept. Thus, the claim is not patent eligible. Independent claims 12 and 19 are rejected based on the reasoning applicable to claim 1. Thus, the claim is not patent-eligible. Dependent claims 2-11, 13-18 and 20 are dependent on claims 1, 12 and 19. Therefore, claims 2-11, 13-18 and 20 are directed to the same abstract idea of claims 1, 12 and 19. Claims 2-11, 13-18 and 20 further recite the limitations that merely refer back to further details of the abstract idea. In addition, the additional limitations (besides those that recite the abstract idea) of the one or more processors, the neural network and the graph embedding system included in the dependent claims 2, 3, 8, 10, 13, 14, 20 that are all recited at a high level of generality to perform the functions of “inputting…the second graph…to generate…the association score for the target entity” (claim 2 and 13); “generating… a third graph based on third characteristics data; merging …the first graph and the third graph into a merged graph comprising a plurality of nodes…; iterating… through each of the plurality of nodes in the merged graph to extract …topology data…; and utilizing… the extracted topology data and label for each node to generate the association score for the target entity” (claims 3, 14 and 20); “generating…one or more second fingerprints for the target entity; inputting…the one or more second fingerprints to determine one or more values each indicative of a likelihood of fraud; and deriving…the association score for the target entity based on the one or more values” (claim 8); “generating…one or more first fingerprints based on the first graph and one or more third fingerprints based on a third graph…; and inputting… the one or more first fingerprints and the one or more third fingerprints …to infer… a likelihood of fraud” (claim 10), such that it amounts no more than mere instructions to apply the exception using the generic computer components. Accordingly, these additional elements do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. The claims are directed to an abstract idea. The dependent claims 2-11, 13-18 and 20 does/do not include additional elements that are sufficient to amount to significantly more than the judicial exception or amount to an inventive concept. As discussed above with respect to integration of the abstract idea into a practical application, the additional elements amount to nothing more than an instruction to “apply it” with the judicial exception. In addition, the additional limitations (besides those that recite the abstract idea) of the one or more processors, the neural network and the graph embedding system included in the dependent claims 2, 3, 8, 10, 13, 14, 20 that are all recited at a high level of generality to perform the functions of “inputting…the second graph…to generate…the association score for the target entity” (claim 2 and 13); “generating… a third graph based on third characteristics data; merging …the first graph and the third graph into a merged graph comprising a plurality of nodes…; iterating… through each of the plurality of nodes in the merged graph to extract …topology data…; and utilizing… the extracted topology data and label for each node to generate the association score for the target entity” (claims 3, 14 and 20); “generating…one or more second fingerprints for the target entity; inputting…the one or more second fingerprints to determine one or more values each indicative of a likelihood of fraud; and deriving…the association score for the target entity based on the one or more values” (claim 8); “generating…one or more first fingerprints based on the first graph and one or more third fingerprints based on a third graph…; and inputting… the one or more first fingerprints and the one or more third fingerprints …to infer… a likelihood of fraud” (claim 10), above amounts to mere instructions to apply the exception using the generic computer components. When viewing the additional elements either individually or as an ordered combination, the claim as a whole does not amount to significantly more than the judicial exception because the claim does not include improvements to another technology or technical field, improvements to the function of the computer itself, and does not provide meaningful limitations beyond general linking the use of an abstract idea to a particular technological environment. In effect, the additional limitations add the words “apply it” (or an equivalent) to the judicial exception, or mere instructions to implement an abstract idea on a computer. Mere instructions to apply an exception using the generic computer component cannot provide an inventive concept. Thus, when considering the combination of elements and the claimed as a whole, the dependent claims 2-11, 13-18 and 20 are not patent eligible. Double Patenting The nonstatutory double patenting rejection is based on a judicially created doctrine grounded in public policy (a policy reflected in the statute) so as to prevent the unjustified or improper timewise extension of the “right to exclude” granted by a patent and to prevent possible harassment by multiple assignees. A nonstatutory double patenting rejection is appropriate where the claims at issue are not identical, but at least one examined application claim is not patentably distinct from the reference claim(s) because the examined application claim is either anticipated by, or would have been obvious over, the reference claim(s). See, e.g., In re Berg, 140 F.3d 1428, 46 USPQ2d 1226 (Fed. Cir. 1998); In re Goodman, 11 F.3d 1046, 29 USPQ2d 2010 (Fed. Cir. 1993); In re Longi, 759 F.2d 887, 225 USPQ 645 (Fed. Cir. 1985); In re Van Ornum, 686 F.2d 937, 214 USPQ 761 (CCPA 1982); In re Vogel, 422 F.2d 438, 164 USPQ 619 (CCPA 1970); and In re Thorington, 418 F.2d 528, 163 USPQ 644 (CCPA 1969). A timely filed terminal disclaimer in compliance with 37 CFR 1.321(c) or 1.321(d) may be used to overcome an actual or provisional rejection based on a nonstatutory double patenting ground provided the reference application or patent either is shown to be commonly owned with this application, or claims an invention made as a result of activities undertaken within the scope of a joint research agreement. A terminal disclaimer must be signed in compliance with 37 CFR 1.321(b). The USPTO internet Web site contains terminal disclaimer forms which may be used. Please visit http://www.uspto.gov/forms/. The filing date of the application will determine what form should be used. A web-based eTerminal Disclaimer may be filled out completely online using web-screens. An eTerminal Disclaimer that meets all requirements is auto-processed and approved immediately upon submission. For more information about eTerminal Disclaimers, refer to http://www.uspto.gov/patents/process/file/efs/guidance/eTD-info-I.jsp. Claim 1 of the instant application are provisionally rejected on the ground of nonstatutory double patenting as being unpatentable over claim 1 of U.S. Patent No. 12,236,490. Both claim 1 of the instant application and claim 1 of U.S. Patent No. 12,236,490 recite a method for determining fraudulent entities. However, claim 1 of U.S. Patent No. 12,236,490 also contains additional limitations not found in claim 1 of the instant application, such as the limitations “retrieving, by the one or more processors, first characteristics data associated with one or more known fraudulent entities; each of the relationships between the target entity and the one or more second related entities as a second connection; generating, by the one or more processors, an association score for the target entity using a first deep learning graph neural network configured to determine whether the first graph and the second graph are similar, wherein the first deep learning graph neural network is trained by: generating a pool of connected components based on the first graph and the second graph, wherein the pool of connected components represents one or more first attributes linked to the known fraudulent entity in the first graph and the target entity in the second graph; iteratively selecting a pair of connected components from the pool of connected components in the first graph and the second graph to compute graph similarity; and training the first deep learning graph neural network using the computed graph similarity to determine a similarity between a pair of graphs; determining, by the one or more processors, that the target entity is an investigative target based on the association score; causing, by the one or more processors, a presentation of the investigative target to be displayed by a graphical user interface of a device, wherein the presentation includes a dynamic representation of a third graph indicating a third connection between (i) the target entity in the second graph, identified as the investigative target, and (ii) one or more first nodes representing the one or more known fraudulent entities in the first graph; and generating, by the one or more processors, computer-executable instructions to invalidate the one or more resource requests associated with the target entity. Accordingly, claim 1 of U.S. Patent No. 12,236,490 is directed to a species of claim 1 of the instant application (see MPEP § 804(II)(B)(2)). It would have been obvious to one of ordinary skill in the art before the effective filing date of the claimed invention to include the additional limitations of claim 1 of U.S. Patent No. 12,236,490 so that the fraudulent entities would be determined/detected would be more efficiently. Conclusion Any inquiry concerning this communication or earlier communications from the examiner should be directed to Tien C. Nguyen whose telephone number is 571-270-5108. The examiner can normally be reached on Monday-Thursday (6am-2pm EST). If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Bennett Sigmond can be reached on 303-297-4411. The fax phone number for the organization where this application or proceeding is assigned is 571-270-6108. Information regarding the status of an application may be obtained from the Patent Application Information Retrieval (PAIR) system. Status information for published applications may be obtained from either Private PAIR or Public PAIR. Status information for unpublished applications is available through Private PAIR only. For more information about the PAIR system, see http://pair-direct.uspto.gov. Should you have questions on access to the Private PAIR system, contact the Electronic Business Center (EBC) at 866-217-9197 (toll-free). If you would like assistance from a USPTO Customer Service Representative or access to the automated information system, call 800-786-9199 (IN USA OR CANADA) or 571-272-1000. /TIEN C NGUYEN/Primary Examiner, Art Unit 3694
Read full office action

Prosecution Timeline

Jan 15, 2025
Application Filed
Jun 26, 2026
Non-Final Rejection mailed — §101, §DP (current)

Precedent Cases

Applications granted by this same examiner with similar technology

Patent 12668149
RENEWABLE ENERGY CREDIT MANAGEMENT SYSTEM AND METHOD FOR USE WITH ELECTRIC VEHICLES
2y 8m to grant Granted Jun 30, 2026
Patent 12664634
SYSTEMS AND METHODS FOR ANALYZING STRUCTURAL DAMAGE IMAGES USING MACHINE LEARNING
2y 3m to grant Granted Jun 23, 2026
Patent 12608743
MACHINE-LEARNING MODELS FOR IMAGE PROCESSING
11m to grant Granted Apr 21, 2026
Patent 12548020
THIRD PARTY PRODUCTS AND SERVICES VIA ATM
1y 10m to grant Granted Feb 10, 2026
Patent 12541790
DIGITAL MORTGAGE APPLICATION SYSTEM AND PROCESSES THEREOF
3y 11m to grant Granted Feb 03, 2026
Study what changed to get past this examiner. Based on 5 most recent grants.

Strategy Recommendation AI-generated — please review before filing

Get a prosecution strategy drawn from examiner precedents, rejection analysis, and claim mapping.
Typically takes 5-10 seconds — AI-generated, attorney review required before filing

Prosecution Projections

1-2
Expected OA Rounds
68%
Grant Probability
86%
With Interview (+18.2%)
2y 10m (~1y 4m remaining)
Median Time to Grant
Low
PTA Risk
Based on 659 resolved cases by this examiner. Grant probability derived from career allowance rate.

Sign in with your work email

Enter your email to receive a magic link. No password needed.

Personal email addresses (Gmail, Yahoo, etc.) are not accepted.

Free tier: 3 strategy analyses per month