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Some Common Medical Practice Accounting Embezzlement Schemes

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Understanding How to Avoid Office Embezzlement

[By Dr. Gary L. Bode CPA, MSA]

Without proper internal accounting controls, a medical practice, clinic or any health entity would never reach peak efficiency or profitability. Internal controls designed and implemented by the practice physician-owner, help prevent bad things from happening.

Embezzlement protection is the classic example. However, internal controls also help ensure good things happen, at least most of the time. A procedural manual or text like: www.BusinessofMedicalPractice.com that teaches physicians how to deal effectively with, and avoid, common schemes is suggested.

Common Schemes

Here is a list of some embezzlement schemes to avoid; however it is imaginative and endless.

  • The physician-owner pocketing cash “off the books”. To the IRS, this is like embezzlement to intentionally defraud it out of tax money.
  • Employee’s pocketing cash from cash transactions.  This is why you see cashiers following protocol that seems to take forever when you’re in the grocery check out line. This is also why you see signs offering a reward if he/she is not offered a receipt. This is partly why security cameras are installed.
  • Bookkeepers writing checks to themselves.  This is easiest to do in flexible software programs like QuickBooks, Peachtree Accounting and financial software [www.Peachtree.com]. It is one of the hardest schemes to detect. The bookkeeper self-writes and cashes the check to their own name; and then the name on the check is changed in the software program to a vendor’s name.  So a real check exists which looks legitimate on checking statements unless a picture of it is available.
  • Employees ordering personal items on practice credit cards.
  • Bookkeepers receiving patient checks and illegally depositing them in an unauthorized, pseudo practice checking account, set up by themselves, in a bank different from yours. They then withdraw funds at will. If this scheme uses only a few patients, who are billed outside of the practice’s accounting software, this is hard to detect.  Executive-management must have a good knowledge of existing patients to catch the ones “missing” from practice records. Monitoring the bookkeeper’s lifestyle might raise suspicion, but this scheme is generally low profile, but protracted. Checking the accounting software “audit trail”, this shows the required original invoice deletions or credit memos in a less sophisticated version of this scheme.
  • Bookkeepers writing payroll checks to non-existent employees. This scheme works well in larger practices and medical clinics with high seasonal turnover of employees, and practices with multiple locations the physician-owner doesn’t visit often.
  • Bookkeepers writing inflated checks to existing employees, vendors or subcontractors. Physician-owners should beware if romantic relationships between the bookkeeper and other practice related parties.
  • Bookkeepers writing checks to false vendors. This is another low profile, protracted scheme that exploits the physician-owner’s indifference to accounts payable.

Assessment

Operating efficiency, safeguarding assets, quality patient care, compliance with existing laws, and accuracy of financial transactions are common goals of internal controls.

Conclusion

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Proactive Medical Accounts Receivable Monitoring

Forewarned is Forearmed

Dr. David E. Marcinko MBA CMP™

By Dr. Gary L. Bode; MSA, CPA, CMP™

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All hospitals, medical clinics, healthcare entities, and doctors are aware that accounts receivable (ARs) represent money that is owed to them, usually by a patient, insurance company, health maintenance organization (HMO), Medicare, Medicaid, or other third party payor. In the reimbursement climate that exists today, it is not unusual for ARs to represent 75% of a hospital’s investments in current assets. And, a medical practice may have ARs in the range of several hundred thousand dollars. ARs are a major source of cash flow, and cash flow is the life-blood of any healthcare entity. It pays bills, meets office payroll, and satisfies operational obligations.

Avoidance Management

The best way to manage AR problems is to avoid them in the first place by implementing a good system of AR control. Answering the following questions may help upgrade a system of AR control:

  • Is an AR policy in place for the collection of self-pay accounts (de minimus and maximus amounts, annual percentage rate (APR), terms, penalties, etc.)?
  • Do employees receive proper AR, bad debt, and follow-up training within legal guidelines?
  • Are AR exceptions approved by the doctor, office manager, or accounting department, or require individual scrutiny?
  • Are AR policies in place for dealing with hardship cases, pro bono work, co-pay waivers, discounts, or no-charges?
  • Are collection procedures within legal guidelines?
  • Are AR policies in place for dealing with past due notices, telephone calls, dunning messages, collection agencies, small claims court, and other collection methods?
  • Are guidelines in place for handling hospital, clinic, or medical practice consultations, unpaid claims, refilling of claims, and appealing claims?
  • Are office AR policies periodically revised and reviewed, with employee input?
  • Does the doctor, hospital, or clinic agree with and support the guidelines?

Assessment

It is  typical that poor control occurs because the doctor and/or hospital is too busy treating patients, or the front office or administrative staff does not have, or follow a good system of AR control.

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Conclusion

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Meet Dr. Gary L. Bode CPA MSA CMP™ [Hon]

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Introducing our Newest Thought-Leader

Dr. Gary Bode; CPA, MSA, CMP

[By Ann Miller RN MHA]

The Medical Executive-Post is proud to introduce Dr. Gary L. Bode as our newest thought-leader for healthcare financial modernity. Dr. Bode was the Chief Financial Officer [CFO] for a private mental healthcare facility, and previously the Chief Executive Officer [CEO] of Comprehensive Practice Accounting, Inc, in Wilmington, NC. The firm specialized in providing tax solution to medical professionals. Dr. Bode was a board certified practitioner and managing partner of a multi-office medical group practice for a decade before earning his Master’s of Science degree in Accounting [MSA] from the University of North Carolina. He is a nationally known forensic health accountant, financial author, educator and speaker.

A Multi-Faceted Healthcare Financial Expert

Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings and innovative financial accounting, as well as proactive tax positioning and tax return preparation for healthcare facilities. Currently, Dr. Bode is Chief Accounting and Valuation Officer (CAVO) for the Institute of Medical Business Advisors, Inc. He is also a Certified Medical Planner™ http://www.CertifiedMedicalPlanner.org  He provides litigation support in his areas of expertise and has been previously accepted as a legal expert witness www.MedicalBusinessAdvisors.com

Assessment

Gary has promised to publish his most exciting ideas and innovative work on our blog. He is also available for private consulting engagements and related professional work on an ad-hoc, or interim basis. So, let’s give a warm ME-P “shout-out” to Dr. Gary L Bode; our newest thought-leader.   

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Conclusion

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