Credit Balances – Low Hanging Fruit Opportunities

The following is Part II in our series – Credit Balances – Management, Opportunity & Challenges. Over the last 20 years, we have found that doctors and the front desk team consistently consider patient credits as “Oh, my gosh, there they are.  If patients want them, they will ask!”  End of story.  What is not considered is the missed “opportunity” of production and revenue for the practice.  Remember, patient credits are money in the bank that is just waiting for the practice to present a treatment plan recommendation that will invest those patient dollars in a healthy, beautiful patient smile.

Let’s consider the true nature and financial impact of patient credits when they are not managed as opportunity, but instead considered, at best, a challenge. When patient credits are sitting on the books, they are generally overstating Accounts Receivable (A/R). Consider the following:

  • Ninety-nine percent of dental practice management software include patient credits in the “current” column of their A/R report.
  • Doing so produces a bogus A/R report! Why? Credits are money owed to patients.  When credits appear on the same report as money owed to the practice by patients, it produces a net reduction in the money due from patients and insurance payers.  This makes the front desk look like they are doing a better collecting job than they are!
  • weaselAs I outlined in Part 1 of this series Credit Balances – Management, Opportunity & Challenges! Part I unattended credit balances can be problematic due to state statues governing patient “Unclaimed Property”.
  • Unattended credit balances can illustrate a need for front desk training on either 1) proper handling of the credits, OR 2) making them work for the practice and patients. Additionally, this may illustrate a lack of oversight by the doctor(s), front desk manager, and/or team.
  • Improper management of credit balances can leave a gap in proper policies and internal controls that could lead to inappropriate activity by a dental weasel thereby causing harm to the practice.

When credit balances are properly managed, the practice produces a win/win situation for the practice and the patient. Here’s how to master the opportunity presented by credit balances:

  • Determine how to run the A/R report excluding patient credits so you know the exact money due the practice every day from patients and insurance payers. This is easy for some software, i.e. Dentrix; however, for others it may take a call to the software vendor support. For example, EagleSoft can be accomplished via an Excel download.  Using Excel you can sort the report so you will know by patient who has the largest credit balance, as well as the total amount of money you “owe” your patients at any point in time.  This can be very critical information when a practice is being sold, etc.
  • Consider a new associate joining the practice with the pressing issue of scheduling production. What sources can these patients come from?  The obvious answers are: new patients, procedure(s) from other doctor(s), referrals, marketing, etc.  Credit balances is another potential source that most practices don’t even consider. Everyone knows the best patients and lowest cost marketing come from current patients.
  • Other reasons to consider patients with credit balances: you need to fill available chair time, you just returned from the greatest CE course, or the practice needs more patients for any other reason. The list of opportunities and long-term positives are limited by the imagination of the doctor(s) and team.  Working your list of patients with credit balances provides you with a deep pool of potential patients and several ways to craft a marketing message that will get those active in your practice again.

For more information about how to produce a win/win situation utilizing your patients with credit balances, give us a call for a free, no obligation 30 minute consultation at 210.241.6329.

 

Educating dentists on identifying embezzlers or fraudsters hiding out in their practices is our expertise. Contact us to speak at your next dental meeting or study club by sending an email to bryant@brytanassociates.com or calling us at 210.241.6329.

Legally Avoid All Credit Card Processing Fees

By Ken Givens, Director of Sales, US Merchant Payment Solutions LLC

Credit Card Surcharge Ban MapPeter Freeman, the co-owner and “head jerk” at a Pharmacy and Soda Fountain shop, said credit card swipe fees are his biggest business expense after rent and payroll. He estimates he spends $15,000 a year on the 2 to 4 percent swipe fees that credit card companies typically charge to cover the cost of processing payments.  Many business owners agree with him!

But now, due to a recent settlement between merchants and credit card giants Visa and MasterCard, businesses in Texas and 9 other states are allowed to offer a discount for customers paying with cash avoiding the Credit Card Transaction costs.  Forty states allow surcharges for card charges as well as cash discounts.

“Retailers offer cash discounts because they want to reward customers for taking [transaction] costs out of the system,” said Jeff Lenard, a spokesman for the National Association of Convenience Stores in Alexandria.

In Australia it took several years for similar action to catch on, but many companies, and then entire industries, began dipping their toes into surcharge territory.  It evolved gradually — one airline would try it and see if they could pull it off, and then you’d see all the other airlines start to do it, too. Then hotels and so on. Now a large portion of the world’s merchants give cash discounts or charge card payment surcharges, saving them thousands in overhead.

Mitchell Katz, spokesman for the Federal Trade Commission, said: “The Dodd-Frank law prohibits a payment card network such as Visa ‘from inhibiting the ability of anyone to provide a discount for payment by cash, checks, debit cards, or credit cards.”

However, it must be disclosed, either with a written policy or conveyed verbally to customers before the transaction.

In Texas, the State Attorney General stated: “businesses can discount the regular retail price of an item for consumers who pay cash.”

https://texasattorneygeneral.gov/cpd/credit-cards

The Texas Finance Code also allows for Cash Discounts, and card payments to be assessed an increase to the ‘regular’ price of the product or service.

Section  339.001  of  the  Texas  Finance  Code states:

  1. Cash discount

Section 339.001 prohibits surcharges for paying by credit card, but it does not  prohibit discounts for paying by cash, check, debit card, or other methods.

Definition of Discount: A surcharge is an increase from the regular price of a good or service, but a discount is a  decrease from the regular price.

The federal Truth in Lending Act allows sellers to have two prices (one for cash and one for credit), as long as the creditcard price of the good or service is also the regular price.

http://occc.texas.gov/sites/default/files/uploads/misc/b15-2-credit-card-surcharge-alternatives-6-25-15.pdf

IMPORTANT TO NOTE: The processing system must have special software so that the ‘regular price’ must show in the point of sale system or the credit card machine receipt to the customer. Per regulations it cannot be added to the price total by hand and then entered into the POS. The receipt must clearly show the original ‘cash discount’ price, and the fee that brings the ‘cost’ to the ‘regular price’.

Want more information on how you can eliminate credit card transaction and processing fees in your business? Ask us for a free information packet called “Reverse Processing”.  Call 888-995-3995 or email FreeConsultation@USmsTexas.com or complete a contact form at www.CardProcessingInfo.com mention ‘Reverse Processing’ to receive the free information.

Sources:

http://www.usatoday.com/story/news/politics/2017/01/10/supreme-court-new-york-credit-card-surcharge-price-speech/96391718/

https://www.washingtonpost.com/business/capitalbusiness/as-rules-change-more-retailers-offer-discounts-for-cash-payments/2013/06/29/d4c84d7a-dcfc-11e2-bd83-e99e43c336ed_story.html?tid=ss_mail&utm_term=.98a67bc7b3d3

http://occc.texas.gov/sites/default/files/uploads/misc/b15-2-credit-card-surcharge-alternatives-6-25-15.pdf

https://www.fivecentnickel.com/states-that-dont-allow-credit-card-surcharges/

https://texasattorneygeneral.gov/cpd/credit-cards

http://www.ncsl.org/research/financial-services-and-commerce/credit-or-debit-card-surcharges-statutes.aspx

 

About the Author:

Ken Givens is the Director of Sales for US Merchant Payment Solutions and has been in the payment processing industry for over 23 years. He has helped businesses of all sizes accept card, checks, and even cash safely and securely.  Ken collaborates with over 25 bank managers around central Texas, including financial institutions such as Frost Bank, Wells Fargo, First State, Horizon Bank, Texas Health Credit Union, and many more because of his one-on-one approach and local support. He provides businesses of all sizes the tools to accept and lower the fees they pay to accept all forms of payments.  His company Guarantees to Lower costs or pay the business $500 for letting them try.  Processing solutions include:

  • Cell Phone/iPhone/iPad/Laptop Card Readers
  • Mobile Wireless Credit Card Terminals with Integrated Printers
  • E-Wallet/Tap-N-Go/ApplePay Card Readers Solutions
  • Computerized Multi Station Point of Sale Registers
  • Ecommerce Sales/Donation Website Integration

Learn more about Ken by contacting him at kengivens@usmstexas.com or calling 888.995.3995.

Credit Balances – Management, Opportunities & Challenges

calculatorThis is the first article in a series that will focus on how credit balances should be managed to provide growth opportunity or handle substantial challenges in your practice.

Today I want to address what to do with credit balances belonging to patients that are no longer “active” for whatever the reason, e.g., death, moved, etc.

The treatment of credit balances is one of the key items we review in every engagement as they consistently receive minimal attention by the owner doctor and/or team.  We often see those balances sitting in the practice management software just getting older and more nonproductive.  Noting this provides significant insight for our investigators into practice management internal controls, training, production, financial management, and other areas of standard patient care.

So what should you do with credit balances? The KEY POINT to note is that states have very specific timelines and procedures for notifying and returning consumer credits before they must be sent to the state as “unclaimed property.”   All states have laws and rules governing “unclaimed property’ that are generally administered by their respective Office of the Controller (or a department with a similar name).  Your specific state agency can be found by Googling “state agency for unclaimed property.”

We often find that our clients do not know credit balances must be consistently managed to insure return to their owner.  We advise them as follows:

  1. Contact your state “unclaimed property” agency for the time line for holding credits before statue, regulation and/or rule requires sending to the state agency after the credit becomes “unclaimed property”. The credit balance becomes “unclaimed property” based on the type of credit balance, e.g., utility deposit, insurance premium, etc. and date established by the state.
  2. Generally, dental and medical credit balances are given a one (1) year due date and must be sent to the state within thirty or sixty days after becoming “unclaimed property”. There will be state paperwork that must accompany each “unclaimed property” credit balance check.
  3. Ask your CPA what documentation you should retain, how to establish a timeline, and appropriate retention method(s).
  4. Make sure to track the receipt of your agency submissions.
  5. Do not be surprised if your state has a “minimum” amount they will accept.
  6. States have considered establishing a statute of limitations after which they can capture unclaimed funds for schools, senior care, veterans, etc. If this happens, discuss with your CPA how to handle this as income.

My next article on this topic will present more detail on managing credit balances by the owner/doctor and front desk team.  This is the key to maximizing opportunities and reducing challenges.

If you want to learn more about how to manage credit balances, give us a call for a free, no obligation 30 minute consultation at 210.241.6329.

 

 

Hiring an Accountant to Keep All Your Worth

By Michael L. DeVries, CFP®, CHBC, EA

I received a call from a client for whom I was doing monthly accounting.  At that time, our services for the client consisted of compiling monthly financial statements, filing quarterly payroll tax returns, annual company returns, and assisting him with various practice management projects. The call I received from the doctor went like this.

“Mike, I’m calling to tell you that I am not going to need your professional services any longer.  My office manager has been doing a great job for me.  Together, we have decided that she could do my monthly accounting using Quickbooks.   We are going to be working with a CPA firm who will use this information to prepare the annual tax returns.  I really appreciate all the work that you have done for me in the past; you have helped me from the start of my practice, but going forward I have decided to use a different approach to my financial management.  I know you don’t agree with this process based upon previous conversations you have had with my office manager when she first approached you about this matter.  I respect your opinion, but I have decided to make this move and I request that you help make this an easy transition.”

I dislike these phone calls. I have had a few in the 30+ years of specializing in helping doctors with their business.  No matter what I try to say to keep the process the same in an attempt to help the doctor, my words fall on deaf ears.  His trusted office manager, who works with him daily, has convinced him that adding this duty to her responsibilities is best for him and will result in a cost savings.  Well … that is until things are assessed again about two years later.  That is when I received another from the doctor.

weasel“Mike, remember when we talked a couple of years ago, and you gave me all the reasons that I should consider keeping  your services rather than having my office manager do that work for me?  Well, I’m sure you do.  I’m calling because I know you would never say, ‘I told you so’ – so, I’m going to do it for you.  Mike, you told me so, and it cost me more money than I care to admit.  We are having an audit done in our office right now, and they figure that my office manager stole hundreds of thousands of dollars since I terminated my services with you.  I’m making this call, not for your benefit, but for the doctors for whom you work.  If any of them think so highly of their office manager that they think that they can replace you and your services, you can tell them my story.”

I dislike these phone calls too. It saddens me to hear of doctors who work so hard to get to this point of their career in medicine or dentistry only to become victims of embezzlement, fraud, waste or abuse from a trusted employee.   The work we do doesn’t guarantee that theft in the practice will not occur.  However, the monthly process that we recommend does make it increasingly more difficult and less likely to occur.

Several years ago I called a good friend who works for a software company that we use to benchmark dental offices.  I had a situation that called for a more detailed review of the possibility of fraud, and I needed someone who could work with me when we suspected fraud within a doctor’s office.  He introduced me to Bryant Truitt, whose passion for helping the client really struck a chord with me.  Bryant and I now partner together when the circumstances call for each other’s expertise.  In my discussions with Bryant, he and I both realized that not all accountants who say they specialize in working with dentists follow a good process for avoiding “fraudster weasels” from sneaking through the back doors of your office.  It is for this reason that I’m offering you my top five standards that doctors should consider when hiring an Accountant:

  1. Give consideration to the phone call I received from my doctor client. It’s a true story and unfortunately I have a few of them.  You need an accounting professional that specializes in serving your business.  Preferably, a person or a firm where working with healthcare professionals is the major part or the only part of their business.  A source for finding such professionals around the country is at the National Society of Healthcare Business Consultants (www.NSCBC.org).
  2. Create a written understanding with the professional you hire that he or she is working for you. The professional you hire will need to have communications with your staff – especially, your office manager.  It’s paramount to keep good relations with your advisors and your team, but ultimately the professional needs to be looking out for your best interest.  This should be done with a service engagement letter.  It troubles me when I receive a call from the office manager inquiring about the services we offer.  I realize doctors are busy – just don’t be too busy to care about this important aspect of your business.
  3. Whether your office is large or small, ask your accounting professional to provide you with an outline of accounting procedures to implement in your office. This would include:
    • Recommended client bookkeeping solutions.
    • Segregation of duties where the accounting professional and you are involved.
    • A process for the daily depositing of receipts and reconciliation of such to your practice management system.
    • Effective procedures for handling money in your practice including Petty Cash.
    • A listing of what information the accountant requires at the end of each month – if it is just your Quickbooks file and the bank statement, you know you don’t have the right professional.  They should also be looking at and spot checking other practice management reports and business records, such as charge and adjustment reports, the accounts receivable aging report, credit card statements, capital equipment purchases, and loan documents.
    • Ability to integrate your practice management system into the financial statements that are compiled on a monthly basis – don’t short-change yourself and business by doing this just quarterly or annually.
    • Options for regular communications regarding your business and the financial management of such.
  4. Look for a professional that provides business advice and not just financial statements and tax compliance. The person with whom you work should have the resources to be able to benchmark your practice to your peers in your specialty and be able to assist you solve a problem when a benchmark is out of line.  The person you hire should be experienced in running a business.
  5. Make sure that the professional with whom you work is well versed in Healthcare Compliance. If the professional you hire isn’t proactive in establishing a Business Associate Agreement with your office, chances are you may have the wrong professional.  HIPAA Privacy, HIPAA Security, OSHA, and Corporate Compliance regarding Fraud, Waste and Abuse can have a major impact on your business.

I started this with a story of a doctor who put a lot of trust in his office manager.  Let me say in ending, that it is good to trust your team – but, it is also good to verify that trust.  Give consideration to these standards when hiring an accounting professional and you will gain an objective trusted business advisor.  An advisor who will work at keeping the “fraud weasels” from making an easy transition – from working for you to working you for all your worth.

We have developed a 5 Minute Fraud Buster checklist to help you identify the simple financial and accounting activities that will make a different in your practice.  Learn more and get your free copy at www.mikeldevries.com/fraudbuster.

 

Mike DeVries is a CERTIFIED FINANCIAL PLANNER ™, Enrolled Agent,  and a Certified Healthcare Business Consultant focusing on helping healthcare professionals. If you would like to learn more about becoming a client, contact Mike at www.vmde.com

 

 

 

Protect Your Practice from Team Member Embezzlement and Abuse with a Fidelity Bond

Protect your practice from dental weasels with a Fidelity BondFacts prove that 80% of business embezzlement, fraud and abuse happens internally by team members!

The Association of Certified Fraud Examiners states that team member dishonesty can range from tens of thousands to millions of dollars.  Our 20 years of investigating dental and medical practices and nonprofits across Canada and the United States have proven losses ranging from $3,000 to $2.1 million!  In 2016, losses of over $1 million was proven by Brytan & Associates professionals.

Is there protection against such losses – YES!  Fidelity Bonds, also called team member dishonesty coverage or crime coverage, are very available to dental and medical entities. It is customizable, inexpensive, and provides protection from $10,000 to $100,000.

Fidelity Bond Defined –

  • Great for dental and medical practices and nonprofits.
  • Fidelity bond is a straight forward insurance policy and does not accrue interest.
  • Can be a part of the practice property or malpractice insurance.
  • Can be purchased as a stand-alone policy or as an add-on or endorsement to another business policy. Ask your agent.
  • Can be issued for specific position(s) or individual(s). Where available, obtain coverage for the entire team as a group.
  • The coverage is for direct physical loss to practice personal property, including money and securities, which results from the dishonest acts committed by the team member(s).
  • Can cover fraud, theft, forgery, disappearance, destruction, alteration of practice documents, unauthorized electronic funds transfers, credit card fraud, computer fraud, money order fraud, counterfeit fraud, etc. It’s critical that you have a clear understanding of what is and is not covered.  Do not be shy about requesting a clear listing before signing on the dotted line!
  • Identity Theft and HIPAA breach coverage is now available from some carriers. Ask about them!
  • Typically, fidelity bonds do not cover accounting or math errors or omissions, government seizure (IRS taxes), vandalism, loss of income as a result of team member crime, fraud involving restatement of any type of profit and loss documents, or policyholder theft.
  • A fidelity bond can be purchased as additional coverage on most business policies.  Amounts will vary, some policies include $10,000 of coverage automatically with the option to increase to $25,000 and provide increases up to $100,000.
  • If unable to add this coverage to an existing business policy, it is possible to purchase a stand-alone fidelity bond.  Prices for this type of coverage vary by number of team members, amount of coverage, and type of dental/medical practice.  An application is usually needed to obtain a premium quote.
  • The cost for the coverage is minimal, usually less than $100/year depending on your business (dental/medical) location. Recently, a client obtained coverage of $25,000 for $92.00 yearly.

Notes on Filing a Claim –

  • If a claim is required, contact the issuing agent and request a claim form. The length is generally two pages and every carrier is different as to the amount of detail.
  • When asked by your agent and carrier as to the amount of loss, it is suggested a general answer be provided such as “the investigation is ongoing and I do not know the amount at this time.”
  • Filing of an initial law enforcement report is required to obtain a case number.  This is needed in most jurisdictions but the execution and handling can vary widely.  Another good reason to consider legal counsel guidance.  The case number establishes that the matter is “real and serious” with the insurance carrier and others.
  • A copy of the law enforcement report must be attached to the claim form.
  • The policyholder will be asked to provide documentation supporting the details of the loss and amount. It is suggested that the details and amount of loss are provided at the end of the investigation and carefully worded.  Clients have found it best to seek legal representative guidance.   Insurance carries do not make any money paying claims.  A copy of the investigation report should accompany the claim form along with the law enforcement report.
  • Make sure to copy everything submitted to the carrier for your records! Send only by “return receipt requested” and track delivery.  Ask your agent the very best way to handle submission to insure proper and timely processing.  Remember, it’s to your total benefit not theirs.

Next Steps – No Debate:

  • Schedule a required team meeting when you receive the policy!
  • Objective is for every team member to know that a fidelity bond is in place.
  • Ask your agent to come and explain to the team what a fidelity bond is, coverage, etc.
  • Do not tell the coverage amount – very important and there is no need to know.
  • Do not go into a detailed explanation about coverage types, e.g., fraud, embezzlement, abuse, etc.
  • Stress positives like document protection, ID theft, HIPAA breach, and others your agent should be able to provide.
  • Mention that law enforcement and the insurance carrier will investigate and determine claim handling. The stated objective:  you, as the policyholder, are really looking out for the team, patients, etc.
  • The principle that should be clearly stated is that others are now part of our team to help protect the practice, patients, team members and our future.
  • Anyone wishing to do the practice harm will very likely already know about fidelity bonds and guided accordingly.

Congratulations, you are the proud owner of great benefits and the lowest cost insurance per thousand you can purchase that I know of.  Just think, it provides the very best for everyone:  reduces stress, provides greater peace of mind, and quietly helps you retire in the manner earned.

 

 

Is There Going to be an Increase in the FLSA Salary Threshhold … or Not?

By Barbara Freet, PHP, President of Human Resource Advsiors

employees-1704059_1280The Fair Labor Standards Act (FLSA) was originally passed in 1937, and it has seen several updates since then with the most recent attempt scheduled to go into effect on December 1, 2016.  As you are no doubt aware, it was delayed by order of a federal judge in Texas on the grounds that the US Department of Labor (DOL) exceeded its authority by raising the minimum salary threshold from $23,660/year to $47,476/year.  What does all this mean?

There are a number of states that use the rules of the FLSA as their state wage and hour law.  In October twenty-one states filed an injunction to halt the enactment of this new rule. Part of the reason goes back to the reason why the new rule was passed in the first place.  The stated intent was to raise the wages of people in low-level managerial jobs, such as those in fast food or retail establishments, by making employers either raise their salary or pay them overtime. Those against the new rule stated that it raised the salary threshold too high too fast.

A word or two of background might help at this point. All wage and hour legislation focuses on the classification of a particular position as “exempt” (meaning exempt from wage and hour law) or “non-exempt” (meaning not exempt from wage and hour law).  “Exempt” positions fall under several categories found in the FLSA and some state labor codes. To determine if a position can be classified as exempt, it has to meet two tests. The first is the “duties test”—do the functions of this position involve high-level training or licenses, is there a lot of independent judgment used and does it require a high level of responsibility? The second is the “salary test”—is this person paid a high enough salary for it to be considered exempt?   The theory is that if you say this person is an office manager but pay her the same wage as your bookkeeper, she is probably not in a position that is given much responsibility because bookkeepers don’t meet the duties test and are almost always non-exempt.

Many people have mistakenly thought that if you pay someone a salary rather than an hourly wage, that makes them exempt. That is not true. If this ruling goes into effect at some point, a lot of positions may meet the duties test but they won’t meet the salary test, which gives employers two choices:  1) give those people a raise so they continue to be exempt and now meet the increased salary threshold, or 2) keep them at the same rate of pay but make them non-exempt and therefore eligible for overtime.

What should you be doing now in this limbo period?  If you haven’t done it already, look at each position in your company or practice and determine the classification of each as either exempt or non-exempt. This is very important. Human Resource Advisors is available to help you review your employee classifications. Contact us at barbara@hradvisors.net or call 925.310.4824.

If you have exempt employees, make sure they are making more than the new anticipated federal rate of $47,476.  If they are, then you are fine; if they aren’t, then you should decide which choice you wish to make: 1) give them a raise, or 2) change them to hourly and keep their salary the same.

One word of caution: CA and some other states have their own wage and hour law which has a salary threshold that has always been higher than the federal threshold. If this law does become effective and the salaries of those considered exempt aren’t at the $47,476 level, you will have to be prepared to raise their salary or make them non-exempt. The rule is that whatever is best for the employee takes precedence. So far this salary rate is the highest in the nation so it would be the threshold that would have to be met by all states.

We don’t know how President-Elect Trump feels about this significant raise in the salary threshold. The ruling could therefore go into effect very quickly, or it could be scrapped because it could also cause a fairly drastic increase in the cost of goods and services. To be safe, you should be prepared by making sure your classifications are correct—that is a good risk management step regardless of how this issue is decided going forward. And then be prepared to give raises or change the classification if this rule does go into effect quickly.

 

Barbara Freet, PHR, is the Founder and President/CEO of Human Resource Advisors, specializing in consulting, product development, sales and training. She is sought out by professional groups and private employers as a guest speaker on a variety of employment-related topics. She founded the company in 1991. Learn more at http://www.humanresourceadvisors.com/. 

Spotting a Weasel: The Personality of a Dental Embezzler – Part VI

This is the final installment of our six-part series on Spotting a Weasel – the Personality of a Dental Embezzler.  For purposes of this series we’ve described each RED FLAG individually, but in reality they are all inter-related. When embezzlement is happening typically more than one RED FLAG is present. This is especially true of the last three we’ll look at in this article. These three are all-inclusive and really tie all of the 18 RED FLAGS together.

Look for additional RED FLAGS in 2017. In the meantime, be on guard at all times. We recommend that you “Trust but Verify.” And, contact us with any questionable situations that you would like outside eyes to help you evaluate.

weaselEagerly Takes Authority and Responsibility

Dental embezzlers endear themselves to the doctor by making themselves seem indispensable. They do this by taking on more and more authority and responsibility to relieve the doctor or other staff members of perceived drama and stress. They accomplish this in a narrative and stealthy way based on their ability to know the personality of the team and doctor.

As they provide more and more insulation for the doctor, they then have the ability to influence the doctor’s decision-making on almost, if not all, levels in the practice. The doctor is left with the feeling that he/she could not run the practice without the dental weasel, leaving the weasel free to run his/her embezzlement schemes.

As the doctor’s confidence in the dental weasel grows, he stops checking in regularly assuming that things are being done properly. He abdicates his responsibility for reviewing reports and practice metrics to the dental weasel handing over more authority and responsibility in the process.

The dental weasel will do everything possible not to surrender areas of responsibility to other team members or the doctor.

As a case in point, we worked with a practice where the doctor hadn’t been looking at practice reports or bank statements for over 5 years.  These reports, along with the practice policies and procedures, were being controlled by the office manager. As the dental weasel’s areas of responsibility and authority grew, they moved in a direction that wasn’t complimentary with the doctor’s financial goals or standard and patient care goals.

Wants Control of Adjustments, Discounts, Write-offs, and Refunds

The single largest way doctors can go bankrupt and/or are unable to retire is through unauthorized discounts, adjustments, write-offs and refunds! Through a series of complex manipulations, embezzlers can use these unauthorized transactions to take money out of the practice and put it in their pocket.

They can also use this practice to endear themselves to patients by giving them discounts, adjusting account balances and write-off fees that are not approved by the doctor. They may even suspend payments for a patient altogether and /or make special payment arrangements.

If the embezzler is in a clinical position they spend an inordinate amount of time with patients discussing the patients’ personal problems. They may affect payment obligations by walking the patient past the busy front desk, or insisting on checking the patient out themselves to “help” the overworked front desk team members. Clinical team members may even intentionally give away services to certain patients in order to further ingratiate themselves.

Discontinues Internal Controls and Policies & Procedures

The very first thing the embezzler will try to do is discontinue Internal Controls and Policies & Procedures as these are a major threat to the dental weasel’s ability to work schemes in the practice. The #1 Internal Control they want to eliminate is a patient sign-in sheet or electronic equivalent.

The dental weasel will also control the reports from the practice management and accounting software by altering the information the doctor(s) receives on a regular basis. The weasel delays and/or eliminates critical reports, including Day Sheets; Adjustments, Discount and Write-off reports; Bank Reports including statements, A/R; Insurance Aging; Credit Balances; etc.

More than 20 years of investigating fraud, embezzlement, waste and abuse in dentistry and non-profits has clearly established “Trust but Verify” techniques. Internal Controls and Policies & Procedures matter – No Debate!  The case outlined above, along with every investigation this year, reinforces the fact they save money, time, stress, and provide better standard and patient care.  The total amount our clients lost this year approaches one million dollars. Over the 20-year period, annual loss per engagement is growing due to the increase in the number and complexity of schemes being worked by dental weasels.

If you’re concerned you may have a weasel in your practice, we encourage you to call us for a free, no obligation 30 minute consultation at 210.241.6329.

Educating dentists on identifying embezzlers or fraudsters hiding out in their practices is our expertise. Contact us to speak at your next dental meeting or study club by sending an email to bryant@brytanassociates.com or calling us at 210.241.6329.

 

We want to thank Karol Peters and Ron Siemering, associates at Brytan & Associates, for their input on today’s article.

Spotting a Weasel: The Personality of a Dental Embezzler – Part V

By Bryant Truitt, MBA, CCS, CFE and Karol Peters, CDC, RDH of Brytan & Associates

This is the fifth installment of our six-part series on Spotting a Weasel – the Personality of a Dental Embezzler. So far, we’ve covered 12 out of 18 of the most prominent RED FLAGS indicating you may have a dental embezzler in your practice. The three RED FLAGS we’re covering today are further ways dental weasels ingratiate themselves with the doctors, other team members and patients to divert attention from the harm they are doing in the practice.

dental embezzlerSecretive – wants private office with door lock

Dental embezzlers truly resemble weasels in their efforts to be secretive about their activities. The dental weasel will want to have a private office with a door that locks for two main reasons:

  1. He/she can create embezzlement schemes in private
  2. It’s a sign of prestige putting the dental weasel in a power position in the practice

Often the dental weasel will gain more authority along with the acquisition of the private office by taking on responsibilities for managing personnel including handling disciplinary write-ups and reviews and managing the ‘locking’ file cabinet of personnel files. In these instances, the dental weasel acquires the role of office manager and insulates the doctor from the stress of managing the practice.

There are many excuses the dental weasel gives for wanting the private office:

  • They can get more work done without interruptions (e.g., general office noise; patient traffic, phone calls, office drama – see below, etc.)
  • They can handle difficult conversations with other team members – these are conversations doctors dread having. However, they are usually ones that the doctor should initiate instead of abdicating the role of leader in the practice. Once this occurs, the office manager is seen as the leader instead of the doctor.
  • It makes it easier for the weasel to do the doctor’s personal business without worrying about other team members being privy to that private information.

For an office manager a closed door is counter-productive to their main role of effectively managing the day-to-day operation of the practice. It removes them from providing timely oversight of the front desk and clinical areas. They are unable to hear things going on with patients that require their input.

No Vacations and/or Days Off and/or Eager to work overtime hours

Team members who want to do the practice harm cannot afford to take a vacation since they run the risk of someone discovering one or more of their schemes when they are not there to handle the cover-up. Additionally, by not taking vacation or time off, it furthers their goal of being indispensable to the practice. The only time the dental weasel takes time off is when the office is completely closed.

Dental weasels will:

  • Come to work even when they’re sick
  • Refuse to cross-train anyone to handle their responsibilities
  • Not take CE courses outside of the practice

The dental weasel looks for opportunities to work overtime. Overtime keeps them in the office by themselves and unobserved. Or, another ploy they use is to request remote access so they can get their after hours work done from home.

Drama – keeps pot stirred

Drama serves the dental weasel in many ways:

  • Drama is a way of distracting the doctor and other team members from the harm the dental weasel is creating in the practice. It keeps the doctor and team members focused on personnel issues, patient drama and/or the practice policies. These are often things that are manufactured by dental weasels to camouflage their schemes.
  • The dental weasel uses drama to gain additional authority, especially hiring, firing and disciplinary actions. Knowing the personality of the doctor and his/her desire to avoid conflict, the dental weasel is only too happy to become more indispensable to the practice by taking on this role. Furthermore, authority in the practice helps the dental weasel get rid of team members and/or vendors who are a threat to him/her.
  • Drama is an often used excuse to gain a private work area because he/she just can’t get his/her work done due to all of the distractions in the practice.
  • The dental weasel’s own personal drama is a way to draw the doctor into his/her crises in turn causing the doctor to empathize with the weasel’s problems.

A Real Weasel from our Files

A classic case from our files involves a weasel who joined a large successful; multi-specialty practice as an officer of the corporation. The weasel started out giving the doctors reports on production, collections and A/R, collectively and by provider. In the months following the hiring of the weasel, things moved along very smoothly. Reports were made available on a regular basis to the doctors, and they were pleased with the performance. As a result of this initial success, the weasel secured a private office in the practice and gained additional authority by controlling hiring, firing and management of all team members both front office and clinical.

Over time, the weasel began discontinuing practice management software reports to the doctors to the point where they were eventually receiving no reports. The doctors didn’t ask any questions about what happened to the reporting. Eventually the weasel discontinued entering invoices, data and other obligations into the accounting software. When asked by the bookkeeper about reports needed to complete quarterly financial statements and tax payments, the weasel would put her off.

During our popular boots on the ground investigation of the practice, we discovered the weasel had successfully blocked all reports going to the doctors, found a way to get credit cards issued in the weasel’s name and became a signatory on the corporate practice account. By obtaining a private office in the practice, the weasel was able to shelter activities to the point that the team and the doctors had no idea what the weasel was doing. This resulted in the weasel being undiscovered for several years during which time over $300,000 went missing.

If you’re concerned you may have a weasel in your practice, we encourage you to call us for a free, no obligation 30 minute consultation at 210.241.6329.

Educating dentists on identifying embezzlers or fraudsters hiding out in their practices is our expertise. Contact us to speak at your next dental meeting or study club by sending an email to bryant@brytanassociates.com or calling us at 210.241.6329.

 

We want to thank Karol Peters, an associate of Brytan & Associates, for her input on today’s article.

 

 

Spotting a Weasel: The Personality of a Dental Embezzler – Part IV

By Bryant Truitt, MBA, CCS, CFE and Barbara Freet, PHR, of Human Resource Advisors
This is the fourth installment of our six-part series on Spotting a Weasel – the Personality of a Dental Embezzler. In today’s article we focus on ways that the dental weasel infiltrates the practice to become an indispensable team member, including handling much of the dentist’s personal business, in an effort to set the groundwork for embezzlement schemes.

Dental EmbezzlerKnows the Personality of the Doctor(s) – Big Time!

There is no doubt that the dental weasel is smart. He/she is excellent at observation, carefully absorbing the personality traits of the dentist to become an expert in how to manipulate the dentist to give him/her more and more autonomy and authority to handle the business aspects of the practice. Dental weasels learn the strengths, weaknesses, idiosyncrasies and, oftentimes, secrets that allow them to control the dentist.

The weasel knows the three most important drivers of the dentist:

  1. Their first love is family – and they consider their dental team part of their family.
  2. They emphasize a high level of patient care – Dentists are highly sensitive to patient issues, especially relieving them of discomfort and providing them with a higher degree of self-confidence through a beautiful, healthy smile.
  3. Love of dentistry – Dentists prefer to stay in the operatory taking care of patients and practicing their expertise

The majority of dentists either 1) have limited knowledge of the front desk, or 2) are relieved to find an office administrator who is expert in the front office to relinquish that part of the business to. As the dental weasel earns more and more of the dentist’s trust, he/she will begin to manipulate the dentist to transition the monitoring of financial reports and practice management software to him/her.

Under the guise of relieving the dentist of stress so he can focus on what he loves to do, the dental weasel:

  • Eliminates the dentist’s ‘need’ to attend software training
  • Eliminates the number and types of reports that the doctor ‘has to’ review
  • Eliminates internal controls in the practice management and accounting software

By the time this happens, one or more scams are already in place.

Does all Hiring and Firing and Wage Increases

Dental weasels will never hire anyone who they perceive is stronger and more knowledgeable than they are, nor will they hire someone they can’t control. They look for team members who

can be molded to be totally dependent on the dental weasel and cover their improprieties. As the hiring ‘manager’ in the practice, a level of authority is conveyed to the office administrator further setting him/her up as the go-to person in the practice.

The dental weasel will often bring family members and friends into the practice to help establish or cover up scams. All hiring of family members, including extended family and friends, must be done with extreme caution.  Frequently the dental weasel will inflate the qualifications of family or friends to make them appear to be the most qualified of the applicants. It is imperative that the dentist, not the office manager or practice administrator, check references on all applicants to confirm their qualifications.  That means calling the doctor in previous practices even if the doctor is not on the list of references provided by the applicant. There are no laws requiring permission to call past employers. I would not call current employers without permission, however.

Hiring, termination and other HR decisions MUST be the sole responsibility of the owner doctor with appropriate advice from HR & legal professionals.  They should follow a well-defined process including starting with written interview questions, utilizing a complete job description, having the applicant fill out an application and then making the offer using a written offer letter.  After hire, all paperwork such as tax forms, an I-9, your employee handbook, and other state-specific required forms should be routinely given and documented, etc. This will show the dental weasel that you are organized and know and will follow legal hiring requirements.

Wants to Do the Personal Business of the Doctor

To further their total control over the dentist, dental weasels take on personal errands for the doctor gradually becoming as indispensable personally as they are in the practice. There are a number of very lucrative reasons for this.

  1. They want to know where the dentist’s personal accounts (banking, estate planning, credit cards, etc.) are to gain access to additional avenues to work their scams.
  2. Knowledge of the doctor’s personal business can give the dental weasel leverage in case he/she is caught in a compromising position.
  3. Our case files include dental weasels who have exploited a variety of improprieties to cover up his/her schemes including personal secrets of the dentist (e.g., mistresses, substance abuse, gambling, misappropriation of funds, etc.)
  4. Eventually the weasel convinces the doctor that he/she needs remote access to do personal business from home so the other team members are shielded from this knowledge. As we pointed out in Part III of this series, remote access is another way a dental weasel gains access to the practice to embezzle and/or do other weasel “business”!

A Real Weasel from our Files

We had a case in California where the doctor’s wife passed away and the trust fund she established was to educate their daughter.  The doctor had no business expertise. The tenured/trusted office manager was given check signing authority to pay the daughter’s education and certain personal expenses.  The OM paid the education expenses as directed but consistently included her personal credit card statements and wrote checks to herself.  We were engaged to complete our popular “boots on the ground” practice review, discovered the six-figure loss, and other schemes.

If you’re concerned you may have a weasel in your practice, we encourage you to call us for a free, no obligation 30 minute consultation at 210.241.6329.

Educating dentists on identifying embezzlers or fraudsters hiding out in their practices is our expertise. Contact us to speak at your next dental meeting or study club by sending an email to bryant@brytanassociates.com or calling us at 210.241.6329.

 

We want to thank Barbara Freet, PHR, President of Human Resource Advisors for her wise counsel on the Human Resources aspects of today’s blog post. 

Spotting a Weasel: The Personality of a Dental Embezzler – Part III

by Bryant Truitt, MBA, CCS, CFE and Ron Siemering, IT Director, Brytan & Associates

weaselThis third installment of our six-part series on Spotting a Weasel – the Personality of a Dental Embezzler outlines the RED FLAGS that arise from the computers and software systems in a dental practice. By recognizing the direct line into the financial systems of the practice that these software programs provide, dental practice owners can better protect themselves from dental weasels who make it their business to become experts in these systems.

Knows computers & software

In the dental practice, accounting software combined with practice management software controls all of the financial systems in the office. The dental weasel knows this and makes it his/her business to know the dental systems inside and out. This expertise allows the weasel to hide his/her schemes behind overcomplicated explanations and so-called ‘system glitches’ that explain away any anomalies.

Knowing that their dentist(s) are not proficient in these software programs, the weasel sets himself/herself up as the go-to person to explain day-to-day transactions and incongruities found in the programs and/or work product.  He/she is the office expert for all of the team members’ questions and issues allowing him/her to maintain oversight and control how his/her scams are being handled in the software. And, although QuickBooks, the predominant accounting software used by dental practices, has an audit trail, many dentists/owners don’t know how to find and protect it.

Furthermore, the dental weasel makes a point of getting to know software and supplies vendors   calling on the practice so he/she can learn new features and more intricate ins and outs of the programs. If his/her scheme begins to unravel, he/she quickly networks with vendors to find other practices using the same programs so he/she can move on to a new target.

A note on protecting yourself:

No one in the practice should have administrator rights over the computer systems or server except the owner doctor(s). Giving the office manager or another team member administrator rights is giving them the ability to control passwords for all team members and delete and/or alter the audit trail to cover her tracks – this is tantamount to a fox in the hen house with no doors – big time!                                              

Wants remote access – Big Time!

As part of the scheme of overall control over financial systems, the weasel is determined to get 24/7 remote access to the computer server to run her scams. There is NO good business reason why any salary or hourly team member should have remote access – no debate. The only person who should have remote access and administrator rights is the owning doctor. Your IT person should also have remote access but with different passwords than the doctor so an audit trail can be maintained.

A note on handling remote employees:

The population of work-from-home employees is growing in the US. We are aware of insurance billing companies who employ retired workers to process insurance claims or handle collections from their residences. There is a safe way to structure their access to practice systems that restrict security levels to only the information necessary to do the job.  

Beware of the team member who wants to work from home on a maternity, vacation, sick leave, claims they can’t get everything done, etc.  We have real dental weasels in our files who gained remote access for this purpose only to steal from the practice.  

Dislikes change – wants 100% control

The biggest threat to the dental weasel is a change in the dental software via upgrade and/or vendor. Learning a new system puts him/her on an even playing field with the rest of the dental team and takes away his/her perceived authority breaking his/her cycle of control. The dental weasel will fight all efforts to change practice management software or accounting practices. This is a definite RED FLAG that a scheme may be present in the practice.

Effective 1/1/2016 Federal HIPAA law requires that ALL healthcare entities must have two structured levels of security in place and change passwords on a regular basis. Many of our clients have a process to ensure that these changes are made twice annually. The dental weasel will combat this process by attempting to maintain the log of passwords and be the person to control the dissemination of new passwords and security levels. No one, not even the doctor(s)/owner(s) should have a list of passwords for team members.  This is one of the schemes in the example below.

A real Weasel from our files:

In a Texas dental practice, the office manager was running scams using the accounting systems and dental practice management software. As the office expert on the systems, all problems, and issues were brought to her attention. Her response would be either ‘it’s a glitch in the software’ or a ‘fat finger error’. She immediately took control of fixing the ‘system problem’. But, rest assured, it wasn’t a glitch. Instead these issues were giving her guidance on adjustments that she needed to make to hide her crime.

She was finally discovered when several front desk team members met with the owning doctor to present how cash was being consistently misappropriated and adjustments applied to cover-up the scheme.  We found 13 schemes used over four years to embezzle over $402,000.

If you’re concerned you may have a weasel in your practice, we encourage you to call us for a free, no obligation 30 minute consultation at 210.241.6329.

Educating dentists on identifying embezzlers or fraudsters hiding out in their practices is our expertise. Contact us to speak at your next dental meeting or study club by sending an email to bryant@brytanassociates.com or calling us at 210.241.6329.