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Lions and Tigers and Fraud, Oh my!

Even More for the Dentist to watch out for?

Fraud that a dentist can be unaware of
More possible fraud to fear?

I was recently at an excellent webinar given by a dentist who served time for fraud. The information that this dentist was giving was totally different from what I expected. I am sure it was also different from what most dentists would expect. However, his story is something to pay attention to!

Now I am sure you are familiar with most convicted criminals stating that they are innocent, they were set up or they convicted the wrong guy. There is a study by the Rand Corporation that shows 15% of prisoners claim innocence. However, this dentist didn't claim innocence but claimed igonorance. Unfortunately the government's position on this does not work in your defense. According to the False Claims Act (FCA), which protects the Government from being overcharged, if a person acts in deliberate ignorance or reckless disregard of the truth or falsity fo the information, it is considered fraud.

I don't know about you, but I see a whole can of worms being opened with this one. How many dentists know everything that is going on at their front desk? As a bookkeeper for Dentists, I can tell you that many rely on the "expertise" of their employees. There are many Dentists who have no clue how to work the Practice Management software outside of the clinical aspect or how forms are filed for a dental claim. Yet, it is their signature that testifies to the information being true and accurate. I have actually had an office manager say to me that the doctor has no clue how to work the PMS upfront and that "they" run the practice. (Scary)

The speaker of the webinar then went on to talk about systems being set up to prevent or catch any errors. As a bookeeper that helps with internal controls, I am all for systems. When followed they can save the dentist headaches in many areas, including fraud. Not only can they cut down on errors but also be a prevention or deterent to fraudulent behavior of staff. Side note: If someone really wants to steal from you they will find a way. Systems can help find their stealing sooner and minimize the damage. Systems in this case of ignorance can be a great protection, but you as the dentist still need to pay attention.

So back to the can of worms. What if it is not just "error that is accidental" because of lack of systems that the Dentist is responsible for? What if the Dentist is responsible for an employees possible "bad' intentions? For example: I had a doctor once tell me that his receptionist could "work her Magic" to get claims paid for. He didn't know how she did it, but she was an expert in this area. Could this be an area of responsibility, according the FCA, if she was doing anything fraudulent? Again, ignorance is not a defense. Lucky for him, his bookkeeper found this front desk person padding the numbers to get a higher bonus and they were let go.

So what other instances ignorance could the dentist be held liable for? Just a thought, but what about not doing due deligence when hiring the person that handles claims? Do you, the dentist do background checks on possible new employees? Especially with the ones handling money. Maybe you think that is overkill? Well, let's take another look at a situaion I experienced with one of my Dental clients. His front desk had left unexpectedly and they were having a hard time filling the position. After months of temporaries filling in, the billing systems was becoming a mess which affected not only the money coming in, but the morale of the whole office. Finally someone answered their ad for the front desk position. She seemed perfect. She knew all the details of their Practice Management software and how to get it cleaned up and on track. In his excitement the doctor hired this person right away, with no background check I might add. Fast forward two-three months later when the doctor starting getting calls from patients about charges on their credit cards they didn't make. The front desk person just happen to disappear before they could ask her about it. A dental fraud specialist was contacted to see what steps should be taken. The first thing the specialist did was to "google" the front desk employee. Low and behold, what came up were her mug shots and the fact that she was wanted in other states for fraud. It can happen and does. What if she was defrauding more than credit cards. Maybe government insurance claims? Would the Dentist be liable here for not doing background checks? Again just a thought, I am not a lawyer.

If you would like to know more on this subject, I can give you the name of the doctor that put on the webinar and the name of the firm (which investigates dental fraud) that hosted him. They have a plethora of good information for the dentist. Also if you are looking for a bookkeeping firm that is very aware of these challenges for the dentist and can help with internal controls, please contact Bookkeeping Aesthetics, LLC or (904) 422-6500.


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