Jaycee Brown

Jaycee Brown

Director of Communications

Reporting Fraud

Dentists may encounter fraud at some point during their practice. When they gather the evidence and accuse the employee for his or her criminal actions, reporting him or her may be expensive for them. However, dentists should report fraud and prosecute the criminals. Afterwards, dentists should work with the employees to better their practice.
Despite high costs, reporting fraud prevents the criminal from committing the same act with other clinics and insurance companies. Dentists can notify “the insurance company, state insurance fraud departments, state department board Office of Inspector General, or [their] local authority” about the fraud (anitra and Schroeder 2017). Prosecuting criminals requires evidence that proves “the case has merit” and is comprehensible, but these requirements can cost a lot for the dentist (Patterson 2018). Also, the Association of Certified Fraud Examiners’ Report to the Nations in 2014 shows, “58% of victim organizations had not recovered any of their losses due to fraud, and only 14% had made a full recovery,” showing that “[the] cost of prosecution is high in energy, time, and money” (Patterson 2016). For those who report Medicaid fraud, they can get whistleblower rewards, which may be “between 15% and 30% of the amount the government recovers” (Howley). Alternatively, dentists, with a legal counsel, could negotiate a private settlement agreement, which costs “less than prosecution,” and, in the end, “some restitution may be made” (Patterson 2018). Unfortunately, this agreement may include not releasing facts of the fraud, allowing the criminal to operate elsewhere (Patterson 2018). Some clinics address the fraud by themselves by firing the employee, for example, allowing the criminal to commit fraud elsewhere (Patterson 2018). In addition, dentists may not prosecute the criminal due to their “[fear] of bad publicity” (Patterson 2018). Prosecuting the criminal may help stop him or her from committing fraud at another clinic (Patterson 2016).
Afterwards, dentists must address the status of their clinic as well as the morale of their staff. Dentists are responsible for not only their financial operations in the clinic, but also their relationship with their employees (anitra and Shroeder 2017). They must show their employees that they value them by informing them “on the latest trends in HR, fraud prevention, and the dental industry” (Dervenis 2018). Dentists should review different aspects of their clinic with their employees, such as reviewing or even making mission statements and revise it if necessary (Dervenis 2018). In addition, dentists should see whether they could “[reward] quality employees with an earned increase or newly added responsibilities” in order to “positively impact office culture” (Dervenis 2018).
Although dentists may choose to minimize the cost of dealing with criminals, they may do so at the expense of letting them commit fraud at other places. Prosecuting them helps stop future fraud from taking place. Afterwards, dentists need to work with their employees to improve their operations and reaffirm their employee’s importance and value to their practice.

Works Cited
anitra and Erin Shroeder. “Dental Fraud: A $12.5 Billion Dollar Problem.” pharmacists mutual,
April 27, 2017. https://www.phmic.com/dental-fraud-12-5-billion-dollar-problem/.
Dervenis, Teri. “The aftermath of fraud begins before it takes place.” DentistryiQ, April 10,
  1. https://www.dentistryiq.com/articles/2018/04/the-aftermath-of-fraud-begins-before-it-takes-place.html.
Howley, John. “Dental Fraud | Whistleblower Rewards.” John Howley, Esq. Accessed June 21,
  1. http://www.johnhowleyesq.com/dental-fraud.html.
Patterson, Jean. “‘The triumph of evil’: When dental fraud goes unprosecuted.” DentistryiQ,
March 12, 2018. https://www.dentistryiq.com/articles/apex360/2018/03/the-triumph-of-evil-when-dental-fraud-goes-unprosecuted.html.
Patterson, Jean R. “When it happens to you: An overview of what to expect when the suspicion
of employee fraud enters your office.” Dental Economics, July 19, 2016.


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