Medical practitioners, including doctors, dentists, and other care providers, have long been an easy target for dishonest employees. Why? It’s simple. Traditionally, medical professionals have had little training in business management. Their focus has been on providing patient care, and the details about the money and the administration of the practice have been up to others.
Left largely unchecked, employees of medical practices often have greater opportunities to commit and conceal fraud. Add to this the complicated billing codes and procedures, the ever-changing insurance reimbursements, and the proliferation of co-pays and write-offs, and medical providers are at an increased risk for fraud and abuse by employees.
There are a multitude of ways to steal from a medical practice. The methods can be as simple as stealing a cash payment made by a patient, to as complex as overbilling an insurance company and stealing the excess funds.
Whatever the method of fraud, it often involves the manipulation of billing records and patient accounts. This can be accomplished with write-offs or alterations to account balances. And this creates a paper trail which may later be discovered by anyone who examines the documentation.
It is helpful to get outside professionals involved in the management of the practice. An outside accountant can independently review the books in order to help look for improprieties. The accountant might also review high-risk accounts, such as a write-off account, to look for unusual activity or a high level of adjustments.
But the best way for doctors, dentists and other medical providers to reduce the instance of internal fraud is by becoming more actively involved in the administration of the practice. This doesn’t mean that the medical professional should be keeping the books or examining each insurance reimbursement. It means that the owner of the practice must oversee the daily operations.
Make employees aware that you are taking an active role in overseeing things. Let them know that you’re going to be examining bank statements, reviewing the numbers, and occasionally looking at detailed documentation. Additional oversight should help reduce the risk of employee theft, because many employees will be deterred from committing fraud simply because they know someone is watching.