Avoid Fraud In The Practice

Posted by Team PracticeForces on Sep 13 2017

Here at PracticeForces, we recognize that practices are committed to serving their patients well. We also know they have valid concerns regarding payment for those services. As a billing company, we are aware that effective collection efforts are vital to a practice's financial performance.


In our latest article on Effective Billing Procedures, we introduced some key concepts for practices to incorporate into their operating processes.

Here are some of the key points from that article:

  • Collect payment at the time of service.
  • Set convenient dates for vendor payments.
  • Pay bills at the end of the discount period.
  • Submit claims electronically.

By implementing these concepts, the practices we serve have seen dramatic improvement to their bottom line and efficiency. For example, a recent half-yearly analysis of our services for an established primary care and geriatrics practice shows that, after taking over from their previous billers, in just over 6 months we achieved a 158% payment increase, and significantly reduced their outstanding A/R (see case study here).

However, in addition to following best practices on managing A/R and implementing effective billing procedures, practices need to be aware of and combat theft in their businesses.

We offer this article as the conclusion of our brief series on managing accounts receivable, utilizing effective billing processes to maximize revenue, and avoiding fraud in the practice.

Tips to avoid fraud in the practice

The reality for many practices is that theft happens. Patients may try to steal services by using another's identity or insurance information. Even employees may steal from their practices. At PracticeForces, we believe the best way to keep your practice free of theft is to create an environment that fosters trust, and to implement preventative measures.

The following are four key areas to address in limiting fraud:

1. Strengthen the hiring process:

  • Conduct thorough applicant interviews.
  • Contact the applicant's previous employers to verify resume.
  • Verify the applicant's graduation records.
  • Interview the applicant's personal references.
  • Conduct background checks on the applicant.

2. Establish policies and procedures:

  • Develop and distribute an employee handbook that details:
    • What is expected of the employee.
    • What the employee is accountable for.
    • The consequences for failing to adhere to accountabilities and expectations.
  • Employee positions should be well-defined.
  • Specific aspects of each position should be listed.

3. Assign individual duties:

  • There needs to be clear delineation on which employees handle what specific aspects.
  • There should be no overlap between the roles, as noted below.  
  • Specify which employees:
    • Handle cash.
    • Manage accounting records. (Not employees who handle cash)
    • Create auditing processes.
    • Reconcile bank accounts. (Not employees who hand cash or manage accounting records)
    • Confirm the identity of patients.

4. Update computer security:

  • Utilize the latest electronic security tools.
  • Limit computer access by:
    • Assigning/creating employee access passwords.
    • Limiting/preventing internet access.
    • Restrict access based on employee responsibilities.


The points above are applicable to all areas of your business, not just the financial aspects. We recommend creating an environment in both the employee and patient facing sides of the practice that encourages communication, honesty, trust, and emphasizes fairness and control. These methods will help prevent theft in your practice.

For more information and additional resources, contact us through the form below or take a look at our range of services.

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Topics: Medical Billing, Improving Your Practice, Revenue Cycle Management

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