7 things that can blow up your practice, and how to defuse them

Every Fourth of July, somebody learns the hard way that the firework that does the most damage is the one nobody was watching. Practices have their own version. The threats that take a practice down are rarely the loud, obvious ones; they are the quiet fuses in the back office, the single points of failure that smolder for months before they finally go off.

Consider just one of them. In MGMA's review of how fraud actually happens in physician offices, the same pattern shows up again and again: one trusted person who records the money, deposits it and reconciles the account, with no one else positioned to notice when something is off. The Association of Certified Fraud Examiners has found that more than half of frauds happen because controls are missing or overridden, and that tips, not audits, catch most of them.

The encouraging part is that almost none of this is bad luck. Each one is a known failure point with a known fix, and most of the fixes are cheap compared with the blast radius. Here are seven things that can blow up a practice, and how to defuse each before it does.