Resources

Protecting dental claims payments with early fraud detection

Written by ECHO | Oct 10, 2024 4:00:00 AM

An ECHO® Fraud Detection Case Summary. Learn How ECHO Was The First  To Flag Abnormal Dental Claims Payments Activity, Leading To The Discovery Of A $250K Embezzlement Scheme.

Case Summary at a Glance

This case summary describes an example of ECHO’s fraud prevention technology and services in action. Automated alerts quickly identified suspicious virtual card processing intended for claims payments on behalf of ECHO’s dental plan partners. Further investigation revealed a suspected $250K in diverted claims payments and other theft that eventually led to an arrest in connection with ten counts of federal wire fraud. The accused pleaded guilty1. At the time of this summary, her sentencing was pending. 

Case Scenario

A Texas-based dental practice began to accept virtual cards in 2018 to benefit from faster, secure, and assured payments, along with enhanced electronic remittance information. In 2020, suspicious changes in card processing triggered ECHO’s protocols for investigation.

An ECHO fraud analyst spoke with the new office manager who tried to assure ECHO the changes in card processing were legitimate. With the findings from in-depth card reviews and spending history, the ECHO fraud team was required to speak directly with the dentist (and practice owner). The office manager intercepted outreach and made reaching the dentist difficult.

With persistence, the ECHO fraud team finally reached him. At that time, it appeared the office manager had redirected 19 card transactions totaling $13,000 in claims payments processed through ECHO. The dentist later confirmed redirected claims payments paid by other plans (not working with ECHO) had gone undetected until ECHO alerted him of suspicious card activity. 

ECHO’s Discoveries Include:

  • The new office manager activated a new card processing terminal and redirected claims payments to her personal account.
  • The new terminal was used intermittently and under a name similar, but different, to the dental practice’s name.
  • A Square card reader was set up and used for the first time.
  • 19 cards totaling almost $13,000 in claims payments were processed fraudulently.
  • ECHO’s investigation and outreach appeared to limit the diversion from claims payments processed through ECHO, yet diversion of payments from other processors continued.

Download the full case summary below.