Another in our series of #TIPS intended to help you manage fraud, embezzlement, waste, abuse; and help keep your practice safe.

This post discusses some of the schemes used by employees to steal from a dental practice. These methods are not specific to dentistry, nor do they require cunning skill and intellect to perform.

I have been uncovering these schemes repeatedly in countless practices since 2004, so I feel it is important to remind every dentist beforehand about the most Powerful Fraud Deterrent ever. (you can read about it here)

Also, I should dispel a common myth that is still held by some dentists; paraphrased as “I believe cash is the only thing that employees can steal.”

For those dentists, they believe employees will not steal checks, credit card payments, patient credits, and so on, because these forms of payment are “safe” and cannot be converted into cash.

This is false.

When an employee decides to steal, anything with cash value can be targeted.

Insurance checks, EFT payments, supplier rebates and refunds to credit cards can all be converted to cash; right in your office.

Things like electronic devices, dental supplies, and office supplies can be re-sold and converted to cash outside your office.

I recall an office that was handing out $25-$50 pharmacy gift cards to patients who met certain spending criteria. Each month, the two employees at the front desk were handing out thousands of dollars in gift cards, when in fact they were keeping all the gift cards for their own use.

Stealing payments for your work – (the most common)

In the blink of an eye, your money becomes their money.

When an employee steals a payment, depending on the scheme used, it may be straightforward or challenging to detect that money is missing.

Consider what happens when an employee uses dental software to record a payment, produce a receipt, and delete the original payment after the patient has left.  

The deleted payment does not show up a day end or deposit report. The employee simply pockets the payment.

The employee then may conceal the theft by (#1) deleting the treatment charges and essentially erasing the visit, (#2) applying an adjustment to offset the treatment charges or (#3) back-dating the payment record.

(#1) deleting the treatment charges

A review of the practice software audit log may show details regarding when payments and treatments are deleted, adjustments applied, or payments backdated.

(#2) adjustment treatment charges to conceal theft

When an employee steals a payment, and leaves the treatment on the books, they invariably have to deal with the charges and account balance.

An account adjustment like “courtesy discount” or “insurance adjustment” can be used. Many employees who steal will apply adjustments to offset the payment, and will often choose an adjustment type that is frequently used.

For example, in an office that accepts Blue Cross insurance reimbursement, it may be common to write off the unpaid balance after the insurance payment arrives. (e.g.: a “Blue Cross Adjustment”)

Because the Blue Cross Adjustment is frequently used, it becomes difficult to separate ‘wheat from chaff’ – identifying which of the hundreds of Blue Cross adjustments are legitimate and which ones are fraudulent.

“Write-offs”, “sent to collection”, and other credit adjustment types are used by the employee to create an appearance of balance in the patient’s ledger; all while draining money from the dentist’s treasury.

Fraud experts agree, the more authority a person has, the more damage they can do. For example, an employee will sometimes use her authority to write off a targeted account as noncollectable.

The idea is that once the account is written off, payments on the account are no longer expected. Of course, the patient has no idea that the account has been written off, so the patient continues to make payments on schedule. The employee steals these incoming payments as they arrive and because the account has been “written off”, there is no likelihood it will become delinquent and trigger suspicion.

Instead of writing off accounts as noncollectable, some employees will post an entry to reduce the balance owing. These are often labelled as a “discount” or “professional courtesy.”

For example, an employee intercepts a $100 patient payment and applies a $100 “discount” on the patient’s account to compensate for the missing money. The employee will generally keep the false discounts small enough to avoid review.

#3 – Back-dating is one of the oldest, and still used, schemes.

It works like this:

What really happened: the patient was billed on March 1 and the patient paid on April 20.

The adulterated computer record shows that the patient was billed on March 1 and paid on March 20.

The employee stole the payment made on April 20 and and recorded the payment (back-dated) is as occurring on March 20.

The payment stolen on April 20 will not show on the daily deposit or monthly totals because the payment was recorded as being received in the previous month.

Cash payments are generally stolen on the same day.

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