Employee Benefit Solutions CFO Sentenced to 66 Months For Role in $33 Million Insurance Fraud Case
Erin Verespy, the CFO of now defunct Employee Benefit Solutions (EBS), has been sentenced to 5 and a half years in prison for her role in an insurance and loan scam that totaled $33 million.
It’s a massive fraud that could have possibly been prevented with the use of artificial intelligence.
In fact, new custom Ai may have been able to detect far more than just this fraud…. And has the potential to actually “predict” the who, what, and where, of many other frauds in the future, before they happen.
We’ll get to this tech breakthrough in just a moment.
In this fraud, Verespy was accused of defrauding multiple lenders and misappropriating client healthcare funds.
According to court proceedings and documents, from 2015 through 2019, Employee Benefits Solutions – which offered third-party healthcare claims administration – controlled the employee healthcare program of a large car dealership chain based in New York.
During this time, the car dealership chain transferred roughly $26 million to EBS accounts to pay for employee healthcare claims.
However, it was found that many of the purported checks on the EBS “check register” were never deposited by healthcare providers. In fact, it was shown that about $17.87 million of the dealership claims payments were misappropriated, most of it ending up in the EBS operating account.
To pull off the scam, Verespy and other co-conspirators would choose which providers would actually be paid and would determine which providers were unlikely to complain about lack of payment… and not pay them at all.
Much of this decision-making was based on which employees of the dealership made the claims.
The stolen claims funds were then used to purchase boats, luxury cars, golf outings and to make mortgage payments.
In addition to the misappropriation scam, it was found that the “check registers” sent to the dealership contained millions of dollars in fraudulent healthcare claims which the dealership was forced to pay.
For her involvement, Verespy accumulated over one million dollars in ill-gotten gains…
Has been ordered by the court to forfeit $1 million, pay over $16 million in restitution and will serve 5 years of supervised release after her prison sentence ends.
The scam ran for years before it was detected. However, new artificial intelligence technologies could have seen this scam long before the authorities figured out what was happening.
Artificial intelligence, especially AI customized for fraud detection in the healthcare and banking system, has the unique ability to monitor millions of transactions and data points, including insurance claims and billing; and it can monitor these data and transactions live, while predicting where new scams may occur.
By incorporating the technology into the transactional stream, frauds like these, and many others, could have been detected and prevented. Discover exactly how, HERE
Or read more about the EBS insurance scam, HERE