9 warning signs an employee is stealing from your practice

The stereotype of the practice embezzler, a shifty new hire skimming the till, gets it exactly backward. In case after case, the person stealing is the most trusted employee in the building: the office manager who has been there 12 years, knows the billing system better than anyone and never misses a day. That trust is not incidental to the theft. It is what makes the theft possible.

The numbers justify a harder look. The typical organization loses 5 percent of its annual revenue to fraud, according to the Association of Certified Fraud Examiners' 2024 Report to the Nations, and the median loss per case runs $145,000, enough to erase a small practice's margin for the year. Most schemes are not caught by audits, either. Tips exposed 43 percent of the frauds in the ACFE's study, more than three times any other detection method, and more than half of all cases traced back to internal controls that were missing or overridden by someone with authority.

The encouraging news is that embezzlement almost always announces itself long before a forensic accountant gets involved. The warning signs are behavioral as often as they are financial, and any physician or administrator willing to look at the operation with fresh eyes can spot them. Here are nine red flags that should make you look closer.