Trojan Today: “Trust, But Verify: 10 Essential Safeguards Every Dentist Should Know” by Christine Taxin

Over 60% of embezzlement cases go undetected. Often, the practice owner identifies issues but fails to report them. It’s essential to report all embezzlement cases to protect all practices—would you really want to hire someone who should have been reported?

Dentists need to be aware that they can also be victimized by someone they consider a “trusted team member.” Since dentists often lack formal business training, they rely on a dedicated team member who may not take time off and might resist any attempts by a consultant to help manage the business effectively.

As a coder and a member of the management team in both dentistry and medicine for many years, I’ve come to realize that doctors often lack awareness of the significant amount of business knowledge required in their fields. It wasn’t until I married my husband, who is a dentist that I truly understood how vulnerable they are to fraud.

In fact, my husband, despite having me work alongside him, faced a shocking incident when the FBI came to our office. Can you imagine the stress that put on him? Our long-time manager was stealing prescription pads, and CVS had to provide the FBI with their audit results, indicating my husband was writing prescriptions for clients in multiple states. Of course, it was not him. When the police visited our employee’s home, they discovered an apartment full of drugs and a list of paying clients across three states.

The deception was heartbreaking, especially since we had celebrated her wedding and witnessed the births of her two babies. Our trust was shattered. We later found money missing and encountered numerous other issues. It’s a stark reminder that appearances can be deceiving; much like a zebra that looks beautiful, its stripes never change.

I have created a list of what I refer to as the “10 Commandments” for managing a practice effectively:

Be Cautious When Hiring

Never fully trust any individual you hire. With over sixty million Americans having criminal records, it is common for people to embellish or provide false information.

Check references. Consider investing in background checks and drug testing for positions that involve the cash flow in your practice.

Understand the Concept of Delegation

Avoid giving one person complete control over any aspect of your practice. Include more than one set of hands and eyes in the daily process of payment collection and recording. This does not preclude a daily review by yet another person.

Monitor Front Desk Functions

Front desk operations should be monitored daily by the doctor and monthly by an outside bookkeeper or accountant. This step is crucial for the profitability seen in Dental Support Organizations (DSOs). A documented, end-of-day review will catch honest mistakes, turn up discrepancies, and deter poor practices.

Guard Against Embezzlement

There is no foolproof way to protect yourself from embezzlement. Any situation that allows an employee to “borrow” money, even with the intent to return it, can lead to a slippery slope. Therefore, maintaining strict control is essential.

Review Reports Daily

Make it a practice to review daily reports, including funds deposited electronically by insurance companies, payments received over the counter, cash, credit card transactions, third-party payments (such as CareCredit), and cash payments. Examine the day sheet carefully to verify who paid at the counter and what claims were settled, ensuring everything matches.

Daily Provider Production Reports

Run a daily report for each provider to review the charges they made that day. Confirm that their documentation and codes correspond with the treatments provided.

Assess Daily Goals

Evaluate the goals set for each day, determine who provided those goals, and identify any goals that a particular team did not meet. Investigate the reasons behind these—were there patient cancellations or treatment denials? Also, ensure you are not paying providers more than necessary based on their production.

Control Access to Systems

Limit team members’ access to only certain parts of your system, allowing you to track who is performing specific actions. 

Monitor System Changes

Learn from your computer system’s trainer how to determine who is logged into an account, especially when changes are made, such as entering payments or charges. A user log for tracking access to PHI is also a HIPAA requirement. Any patient can request to see the names of all individuals who have accessed their protected health information (PHI).

Weekly Chart Reviews

Establish a system to review five charts weekly with each provider. This review should focus on documentation, codes used, and charges from their daily production report.

Following these guidelines can help safeguard your practice and ensure a smooth operation. If you believe you have problems in your office with your process or access to payments or that discrepancies are showing but you do not have the experience to sort them out, look for a specialist. Accountants and embezzlement experts exist in the dental profession. Reach out for help.