By Larry Wintersteen, BA, MA, CMT
Published: Dental Practice Management – Canada

Traditionally I am not a negative person, nor do I want to focus on negative subjects. However, periodically it is smart to get in touch with reality. Please accept and realize that your Dental practice is not immune from the ugly possibility of Embezzlement. As a Practice Management consultant, since 1974, I am sad to say that I have witnessed an alarming increase of Dental Practice Embezzlement heart ache. It is the private stories, the affected lives, the periodic questions and the frequency that has prompted me to write this article.

Needless to say I am awkward and hesitant to share this information. My hesitancy comes from the fact that this article is being read by those wanting to protect themselves and also being read by the “thieves” or potential thieves. This information can be used for either camp. Consequently, I must work on the premise that integrity is the primary motivation for reading this article. Yet, if your motivation is prompted otherwise – then I should shout loud a clear that all victims of Embezzlement should be prepared to:

Warn ALL employees of the consequences – when caught Automatic Dismissal Register crime with the authorities Legally prosecute – to the fullest degree Require restitution Be willing to forgive & forget Insist on professional help and a strict probation.

WHERE DOES the “E” word START? In preparing for this article, I personally interviewed 15 individuals that have been caught and prosecuted for Embezzling funds in the Dental office. Their remorse, their justification and their personal stories are all different. When asked to qualify their thinking and behaviors, they shared the following quotes: (Remember, none of these thoughts justify the act or behavior of Embezzlement)

  • “It was just easy to take a little bit at a time.”
  • “Dr. always took money from the petty cash and never paid it back. I guess I felt like this practice was just as much mine as his.”
  • “Dr. wastes more money than I ever took.”
  • “I figured Dr. gave so much dentistry away, that he surely isn’t going to miss a few dollars here and there.”
  • “He never appreciated what I did, nor would he consider a raise without my begging – so I guess I just gave myself a raise. To hell with him!”
  • “Actually, I would have never been caught had I not taken a lunch hour.”

Let’s talk about this last quote. It’s an insightful, true case history.

This particular receptionist had been working in the office for approximately 15 months. She was the only full time receptionist. Once in awhile she would have a helper. For the most part she ran the front desk and compiled all practice reports. One day, when she was away to lunch, the telephone rang. The Dr. happened to be in the building and quickly answered the phone, thinking it was a call he was expecting. It was not his expected call. It was a patient wanting an itemized statement to verify receipt of personal payments to the office. Also, the patient was trying to qualify that his son had given the receptionist $100.00 cash ,during his last visit. His last statement simply indicated a balance due and the patient was confused as to whether the payments received were cash, patient check or insurance check. The Dr. thanked the parent and assured him that the itemized statement and form of payment history would be in the mail, promptly. He shared this parent request with the receptionist, upon her return from lunch. She immediately responded – “I will take care of it – I do remember the son giving me $100.00.” The next day, the Dr. asked the receptionist – “how should I answer payment questions for a patient if I were to pick up the telephone again. For example, how do we keep track of cash payments?” The receptionist said, “that’s easy, you would simply refer to the cash receipt book or the computer payment entry”. She then showed the Dr. how to get in and out of the computer, which indicated a $100.00 adjustment, but not a payment. Funny thing – there was also no entry in the cash receipt book. Of course she gave all sorts of reasons why she had not finished the transaction and again assured the Dr. “I will take care of it”. The Dr. smiled – said Thank You – and proceeded to his office where he called his accountant and said, “we need to talk”. For the next week, a team of 3 people examined and evaluated all transactions for a 6 month period. The evidence was conclusive . . . . there was a “thief” in the front office. The Dr. and his accountant confronted the receptionist.

She could not argue the documented evidence. She was caught. She was assured that they would continue to audit all of the records since her first day of employment. The end result was alarming. Over a 15 month period she had personally taken over $50,000.00 from the practice, that was documented. (That’s over $3,000 per month) Who knows what else she covered up. I will spare all the other ugly details, other than to say she had very little remorse, the money was all spent, she received maximum reprimand and she devastated her husband and their family unit.

From this case history and unfortunately, many others, may I offer some sound advice and warnings.

PREVENTIVE MANAGEMENT IDEAS

Be an Active Leader: It is important that the Dr. participate in the management of the front desk. Act like you care about the business ends of the practice and understand the business systems that are utilized in your office. ALL policies and practices, pertaining to handling money in your office, must have your sanction and approval.

Review Your Numbers: Discipline yourself and calendar a routine review of your financial statements and practice statistics. Learn how to retrieve and track practice data. Interpret your numbers and confirm their workability and feasibility. Periodically, unannounced, reconstruct a day. Make certain that you can track all patients that have been seen in a given day and also how the monies or postings were recorded.

Monitor Your Bank Statements: Make certain that your staff knows that you look at your monthly bank statements. In fact, you should be the person to open your bank statements – review them, and then have a third party balance and account for the practice check book. Do NOT use your receptionist for practice payables/checking.

Request Canceled Checks: It is important that you inspect all canceled checks for unusual amounts, payees or endorsements. Make certain that you have your actual checks , or copies of – returned with your statement each month.

Review Invoices: Never sign a check without reviewing its corresponding invoice.

Stuff and Mail: Dr. should sign the checks, stuff and seal the envelop. Then have a person other than the one making out the payables, mail the checks. Ideally, the payables should be mailed by the Dr. or the Drs. spouse.

A.R. Review: Establish a set time with your receptionist to review all aged accounts (weekly/monthly). Look at each account with your receptionist. Talk about aged accounts and payment history.

Review Adjustments: At least once a month review an alphabetical list of all write- offs, adjustments, allowances and bad debt. Make certain the receptionist or person working the Accounts Receivable are participating in this review.

Budget: Take an active part in the budget process. Establish a budget for each business year. Monitor expenditures on a monthly basis. Evaluate your overhead expenditures and percentages – per category. Make certain your receptionist knows that you look closely at all payable entries and the returned checks. Use Quick Books Pro – for example to create an office budget.

Look at the Check Book: If someone else is entering your payable & deposit transactions into the check book, make it a point to look at the checkbook often. Absolutely do not allow whiteout to be used in the check book. If anything is voided . . . . simply draw a line through the entry . . . so it can still be read.

Bonded & References: Employees that are individually involved with handling practice monies should be bonded. Also, make certain that your practice insurance addresses the possibility of embezzlement coverage. Please check out references carefully, before hiring a person to handle your money and practice accounting.

Quarterly Review: At the end of each quarter set up a review time with your accountant or another professional advisor. A third party can often times sight unusual amounts or percentages. If so, you can then investigate a little more carefully. Again, I stress the importance of discipline and regular calendar review dates.

Cross Train: No one person should be empowered with total control of your front desk. It is important that you cross train for coverage and an extra set of eyes and ears. If you do not have another person to cross train, then the Dr. or the Dr’s spouse should make certain that they can understand the basic essentials of the front desk. Especially the receiving of money and the posting of.

Defer “alone” Time: Many schemes are developed when the receptionist is alone in the office. Insist that they come and go with the other staff or the Dr. You may be impressed when you see them going the extra mile and spending added time in the office . . . . but, it can also be very dangerous. Having other people around can deter wrongful manipulation of figures, postings and reports. Also insist that receptionists take vacations.

Daily Deposits: Deposits are to be made on a daily basis. Never let deposits accumulate. All postings must be done on the day of treatment or within 24 hours of treatment or any business exchange.

Computer “hideouts”: It is easy to hide things in the computer. Have a third party, that understands your computer, show you how and where monies or embezzlement behavior could be masked in the computer. Have them teach you how to interpret the computer reports and how to cross reference the reports.

Cash Practice: Join the many practices that are rendering services for cash only. Then you have to make certain that your production is being billed out in full and that your deposit slips match the production report. Again, track your posting and the form of payment received – cash, personal check or insurance check.

These are but a few pre-cautionary measures you can take to help prevent embezzlement. The key is – Be involved with the Business. Stress the importance of accountability and responsibility with self and staff. They must know you are keeping your eyes and ears open for inappropriate behavior. Consequential communication can be threatening to some, but most employees want to know the rules, regulations and consequences of inappropriate activities.

HOW TO STEAL FROM A DENTIST Often times a Dentist does not know what to look for. In fact, they are apprehensive to examine things, for fear of destroying trust or team spirit. Yet, through controlled staff interaction and private examination time, you can be better safe than sorry. Prevention through awareness is valuable and helpful. I am constantly amazed how creative people can become – to be dishonest. The following activities have actually happened. Don’t let them happen in your practice:

  • The cash patients have been overcharged and the difference has been pocketed. (Cross reference your cash receipt book to the billing statement.) You can’t have a difference of amounts.
  • Staff has used the company credit card for personal use. (Carefully review your statements)
  • They take cash from the deposit and then alter the deposit receipt before arriving at the bank. (Verify bank statement deposits with the actual deposit book or computer deposit print out.) Remember, to take your own deposits to the bank or have a bonded service collect your deposit.
  •  A new bank account has been opened in the Drs. name and the person puts their name on the signature card. Some monies are deposited there for later withdrawal. (Please open all bank statements).
  • Checks have been made out to fictitious vendors and the monies have been shared after the check has been cashed. ( Its called cooperative embezzlement)
  • Fake bills have been submitted to insurance companies for friends and families – who then receive insurance payment – to be shared later. (Insurance fraud is very dangerous and STUPID!)
  • CHARGE services have been posted for family and friends without written Dr. approval. (A token payment is given to say Thank You)
    Checks have been written to self for a supposed reimbursement. (Before signing a personal check, see an attached reimbursement form and merchandise receipt.)
  • Checks have been made out to CASH. A familiar face can get away with this at a bank by utilizing a rubber stamp Dr. signature or forging the Drs name. (No rubber signature stamps in the office.)
  • Many dollars go out the door by staff utilizing practice postage, supplies, equipment and company time. (Make a firm policy statement to all of your employees. Carefully define what is proper and improper.)
  • It is common and easy to “borrow” from the petty cash or counter cash drawer. Make certain that your counter cash is separate from your petty cash. (Review and balance your petty cash each week and your counter cash daily.)
  • Too often, surplus supplies, drugs, equipment and marketing items are ordered and the additional inventory is taken home. (Track inventory in/out )
  • Blank checks have been signed by Drs as they are hurrying out the door for a vacation or whatever. (Never do it!)
  • A Dr’s spouse or Dental partner – with signature power – is in cahoots with a staff person to embezzle funds. ( Require 2 owner signatures – one being the major share holder.)

Imagination, courage or stupidity can add to this list. Frankly, as mentioned, I am a bit nervous sharing this information for fear of what can be done with it if it gets into the wrong hands. But, as they say . . “If a person chooses to be dishonest , it will catch up with them some time – in this life or the next one. Or as another person stated – “If they are dishonest and seem to get away with it . . . may they burn in Hell!”
Remember, you believe in Preventive Dentistry . . . why not Preventive Business Practices.