North Texas Dentistry Volume 8 Issue 5 2018 ISSUE 5 DE | Page 14

fraud alert
The
Healthcare
Fraud
Epidemic
by Richard V. Lyschik, DDS, FAGD, CFE
Many dental practice owners are more likely
to entrust a single individual with multiple
tasks, such as managing the business’ books
and records, while also accessing its bank ac-
counts. But that type of arrangement can give
a fraudster “the keys to the castle.”
What should more dentists know about healthcare fraud?
Healthcare is particularly susceptible to fraud because of the
endless variety of schemes and perpetrators. Fraud occurs at all
levels, from the smallest “mom and pop” practice to the multi-
million-dollar facility. Between charging for procedures not
done, upcharging for those that were done, and kickbacks be-
tween doctors for referrals to each other, there is a lot of oppor-
tunity for fraud to be committed by the doctor.
But the list of perpetrators in healthcare fraud goes beyond just
doctors, partners and employees. Landlords, lawyers, equip-
ment and supply vendors, and many more individuals providing
services and goods to the doctor’s practice can potentially com-
mit fraud. Lately there has been an increasing fraud trend with
third-party individuals and companies that offer to come in to
manage practices. They promise to grow the profits of the prac-
tice, but then take advantage of the healthcare professionals’
lack of business acumen to use the dental practice as an oppor-
tunity for fraud.
14 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
What are the most challenging aspects of investigating dental
practice fraud?
It is shocking at how difficult it is to get dentists to believe that
there could be fraud in their practice and just as hard to moti-
vate them to clean it up. When discovered, a large percentage of
the healthcare fraudsters are the employees with the most sen-
iority. Not surprisingly, many doctors’ initial reactions are that
they don’t want to “rock the boat.” They don’t want you to upset
the practice’s cash flow, or their personal lifestyle, and they don’t
want to go through a stressful firing and hiring encounter with
the potential fraudster. Doctors also worry about upsetting the
morale of the other employees — they often say, “What are the
other staff going to think?” Some doctors believe they can solve
the matter by having a staff meeting, and others have even
naively thought that if they speak to the fraudster themselves,
that the fraud would stop occurring. They think they can “solve
the problem” themselves! They have heard too often the stories
of employee retaliation in other healthcare settings.
What is your most memorable dental fraud case?
I will never forget the office manager who took home the entire
office computer while the doctor was on vacation. She had it
cloned by her uncle to capture more than 2,000 patient records
filled with social security numbers, insurance policy numbers
and credit card data. When the doctor returned from vacation,
and suspicious credit card charges appeared on patients’
monthly statements, it was discovered that the office manager
went on a shopping spree for jewelry, exercise clothes, diet pills
and more. My team assisted the doctor in the proper termina-