Physician Beware: ‘Keep Yer Hands off My Cash’

January 1, 2009

Each issue we’ll help you steer clear of hidden pitfalls. This month: Your favorite employee is sweet to you and patients, makes the World’s Best Brownies, and never takes a vacation. But is she robbing you blind?


Of the entire population, 10 percent is completely and utterly honest, even if no one’s looking. Eighty percent is less saintly, but too scared to steal. The rest? Crooks.

These are back-pocket stats espoused by practice management consultant Gary Steinberg of Jenkintown, Pa.-based Practice Healthcare Solutions - borne out of 30 years of observational experience in medical administration and consulting. “Most people are honest and wouldn’t steal,” he says. “But there’s the issue of the person who perceives the doctor is making all this money, and they’re making $12 an hour, so what’s the big deal?”

The big deal, of course, is the stealing part. The amount varies widely, from gas money to millions, as does the job title of the perpetrator, says Rick Glaser, a partner with Parker Poe law firm in Charlotte, N.C. “It runs the gamut,” he says. “You’ve got office managers who have control not only over receipts but also putting money in checking accounts. Or it can be as easy as a front-desk person taking money. But that’s not where it begins and ends, either. You have an awful lot of honest receptionists. Physicians take from other physicians, not just by putting their hands in petty cash, but by misreporting hours.”

Regardless of who’s doing the stealing, doctors are often easy targets. After all, your staff is there to manage the business side of the practice while you focus on medicine, right? Wrong. It’s your business. Abdicating your responsibility as the leader and expecting your staff to run a tight and profitable operation with little or no accountability is inviting trouble.

Yet there’s no need to go crazy with oversight. Micromanaging will suck up your valuable time, stress you out, and make you a very unpopular boss. But you can pay closer attention to the business side without becoming obsessive by setting up check/balance procedures, such as:

  • Require that two people are involved in every money transaction. Collectors should never be depositors.

  • Make sure your money collectors promptly record all transactions, including copays, write-offs, and the like - especially if cash is changing hands. Also, require them to write a receipt for absolutely everything, no exceptions.

  • Reconcile receivables and chargeables every single day.

  • Have payers and patients direct checks to a bank lockbox to preclude mail theft, which Steinberg says is scarily common. Even if checks are made out to the practice, an enterprising embezzler working in an oversight-free environment can find a bank - often overseas - to accept a third-party check, says Steinberg. “It’s that flagrant.”

  • Heavily encourage the use of credit/debit cards for patient payments. Yes, you’ll pay a merchant fee. But you’ll get your money much faster and there’s that much less cash lying around, waiting to be pilfered.

  • Get rid of your signature stamp. Yes, you’re busy, and they can be a time-saver, but there’s just too much risk associated with such stamps. Glaser even thinks they should be outlawed, saying, “If a stamp exists and people know where to find it, it’s so easy to abuse it.” Besides, consider that requiring someone to get a signature from you is a very effective oversight tool.

Once a year, hire an outside source to perform a practice-wide audit on your practice - not just to ferret out any fiscal philandering, but to see where soft spots may have developed in any aspect: staff size, resource usage, billing practices, and so on. A consultant will assess your practice with an objective eye, and the money you save by annually retightening your practice lug nuts will more than make up for the associated fee.

Finally, write down all your money-handling procedures in a formal document and distribute it to your staff in an upcoming staff meeting. Do this even if you’re 100 percent certain no thieving shenanigans are currently underway. Your staff will get the message: You’re no fool about such things, so no funny business.

Remember, even pinching enough to fill a gas tank - say, $50 a week - totals out to more than $2,500 a year. So although establishing an antitheft environment will take some thought and time, can you afford not to do it? After the initial set-up, you only need to keep tabs with spot checks. “If [he’s] got the processes in place, the doctor can dip in and see it’s working,” says Glaser. “The greatest deterrent is knowing someone is noticing.”

Shirley Grace is an associate editor for Physicians Practice. She can be reached at shirley.grace@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.