Frauds by Employees
Dentists can commit fraud in order to get more money by “[billing] for services not rendered,” intentionally sending wrong codes to insurance companies, upcoding, etc. (Lewis Jr. and Farragher 2013). When they get caught, dentists pay fines, serve prison time, and live with damaged reputations. However, their employees can also commit fraud secretly (Lewis Jr. and Farragher 2013). Their employees’ actions damage dental practices financially. Dentists must make sure their employees are not doing anything illegal.
Employees’ illegal actions hurt the dental practice. Unfortunately, the dentist may not notice them for a long while (Lewis Jr. 2013, 67). Some dealings related to fraud may involve “write-offs, payment adjustments, charge adjustments and backdated accounts… and in aggregate, they impact the income of the practice” (Lewis Jr. 2013, 67). Regarding frauds involving dental claims, “an employee was committing insurance fraud by submitting false claims and having the remittance sent to the employee’s address. Although the practitioner did not commit the fraud, he was forced to refund the monies falsely remitted, and is under investigation by state authorities” (Lewis Jr. and Farragher 2013). Another clinic got involved with insurance fraud when the employees utilized upcoding in order to receive more money for the clinic and themselves, the dentist unaware of their actions (Lewis Jr. and Farragher 2013). When the insurance company became privy to these codes, it started to watch over “the claims submitted by the practice” (Lewis Jr. and Farragher 2013).
Dentists should prevent and detect fraud committed by their employees. Dentists should always review their backgrounds and “references from former employers” thoroughly (Giovenco 2016; Lewis Jr. and Farragher 2013). Employees may be committing fraud if they are, for example, “[living] beyond one’s apparent means,” “[appears] to be the ideal employee; first to arrive and last to leave,” “[may] work when the office is normally closed (evenings or days),” “[maintains] excessive control over his or her work function,” and more (J. Patterson 2016). Dentists should allocate tasks to different employees because if a single employee deals with a lot of tasks, “an employee can have the ability to not only create the fraud, but to control the cover up” (J. Patterson 2016). Dentists should also restrict access to different types of information in dental and accounting software to specific staff members in order to prevent fraud (J. Paterson 2016). Dentists could rely on their spouse, practice management team, and accountant to “help [the dentists] understand the proper workload allocation and the reports needed for proper practice maintenance” (J. Paterson 2016). Audits and third-parties, such as a forensic accountant and a law enforcement officer, could help dentists look for fraud by employees (Lewis Jr. and Farragher 2013; J.R. Patterson 2016).
Staff members can help a dental practice thrive and function, bringing in revenue. While dentists should be grateful to their employees, they should remain cautious and alert because one of them may commit fraud for their selfish gains.