34. Signs of embezzlement in your dental practice and how to avoid it
With David Harris
David Harris has one of the most interesting jobs in dentistry.
When office managers, staff members, or business partners steal from dental practices, it's his job to uncover the embezzlement, stop the crime, and document the evidence needed to fire and convict the perpetrators.
After doing that job for more than 30 years, he's seen and done it all.
Meet our guest
Today, David is the Chief Executive Officer of Prosperident, the world’s largest firm investigating financial crimes committed against dentists.
As a licensed private investigator, a Forensic Certified Public Accountant, and a Certified Fraud Examiner, he is the author of two books on embezzlement, and a frequent presenter at regional, national, and international dental conferences.
In this episode
- What are some instances of dental embezzlement that he has personally uncovered?
- Why are dental practices such easy targets for thieves?
- What are some red flags that might indicate theft is taking place in your practice?
- How should a dentist respond if they think embezzlement is happening in their practice?
- What are some common-sense best practices to prevent theft?
He took me over to the suspect's workspace and I started going through her drawers. Thieves often need to write down what they're doing so that they can keep track of what's real in the patient accounts and what's fiction. And what I found was her cheat book taped to the bottom of a drawer.
Welcome to The Path to Owning It podcast by Provide, hosted by me, Corey Brown, a marketing leader at Provide with over a decade in the health care industry. If you've found us, you're likely an aspiring or established health care practice owner looking for tools and advice to begin your journey, or take your practice to new heights… and you're not alone.
So to help you achieve your practice ownership dreams, twice monthly we’ll tap into our unparalleled network of industry experts who will join us on our quest to provide the answers to your most pressing questions. Like what you hear? Follow us on Apple Podcasts, Spotify, or wherever else you listen. Today we are joined by David Harris, the chief executive officer of Prosperident at the world's largest firm investigating financial crimes committed against dentists.
David is a licensed private investigator, a forensic certified public accountant and a certified fraud examiner. He is the author of two books on embezzlement, and in addition to being a prolific author, David is a frequent presenter at regional, national and international dental conferences. David, I'm so excited to have you here today. Welcome.
Great to be with you. Corey I'm looking forward to our conversation.
Yeah, me too. You know, this topic is very interesting to me, and you have one of the most interesting jobs in dentistry. You get to chase and catch those who steal from dentists. How was it that you fell into this niche?
Oh, gosh, I'd love to tell you that I had a business plan and I saw an opportunity and I went after it. The truth is a little more accidental than that. I got kicked out of high school. I ended up joining the army because it sounded a lot better than jail, which was the other choice. I really flourished in the army and they were kind enough to educate me a bit.
Eventually, I left the Army and I became a long haired civilian. I was sitting at home, bored silly, and trying hard not to think about what I was going to do when I grew up. And the phone rang and it was a guy I'd been in high school with in my brief visit there who had become a dentist.
And he said to me, I think my front desk person is stealing. And David, I have no one else to call about this. I was really looking for a diversion. So I said to my friend, I'll meet you tonight at your practice after you close. So I went over to his practice that night and I said, “Show me where she works.”
And he took me over to the suspect's workspace and I started going through her drawers. And of course, I thought my friend was going to swallow his tongue. You know, he wasn't sure we could do this. You know, it would be some kind of invasion of privacy. And I told him, no, it's okay. We're quite allowed to go through your drawers of the desk you own in your office.
And what I found underneath one of her drawers, Corey, was her cheat book. It was taped to the bottom of a drawer. Thieves often need to write down what they're doing so that they can keep track of what's real in the patient accounts and what's fiction. Now you're more likely to see an Excel spreadsheet. Or maybe the patients are coded slightly differently in practice management software so that you can pick those patients out.
You know, something like that. But in those days, it was an old fashioned notebook. So once I had the notebook in my hand, the whole thing kind of unraveled pretty quickly. And a couple of hours later I had a pretty good picture of what had happened in my friend's practice. The amount stolen was around $30,000, which would not be noteworthy today, but it was then.
So I came back the next morning, we got her fired and my friend promised to buy me dinner that I'll mention I'm still waiting for… and two weeks later I had an appointment at my own dentist's office. Imagine the jolt of lightning I got. I was about to go inside and I looked through the glass panel in his door and sitting at his front desk was the same woman I held fired my friend's office two weeks ago.
Whoa. What are the odds?
I said something I won't repeat. I turned around quickly, hoping that she didn't see me. I sprinted to a payphone because, of course, in 1989, you just didn't carry a cell phone.
Call the practice. Used a little bit of deception to get through the gatekeeper and get my doctor on the phone. And I just told him about the time bomb that was ticking away at his front desk and he panicked and hired me. And that was my first client.
Wow. That's an unbelievable story. How did you go from that to where you are now?
Well, in those days, it was pretty rudimentary. Typically, the doctor would meet me after hours and hand me the keys to the practice and say, okay, you have to be gone at 7 a.m. because the staff start getting here at 7:30. You’d do it on site because there was no other way and you'd work all night. What really changed things and fueled our growth was first of all, practices computerized.
And then secondly, when those computerized practices got hooked up to the Internet because then suddenly we could do this at a distance. So that's when we really started to grow. We're now about 25 people.
Yeah. So why is it that dental practices are such often targets of theft in your opinion from all that you've seen?
I think it's a lot of factors coming together. You know, And the first thing is that… and the title to my new book, Corey, is Healers versus Stealers. I know very few dentists who decided to go into dentistry because they really wanted to own a business. Almost every dentist I ever met wants to help patients. That's all they want to do.
And the kind of unwanted stepchild of the marriages that they also have to run a business. So there are definitely some dentists who rejoice in running a business, they're very much in the minority. The second factor, of course, is knowledge. I mean, a lot of dental schools don't even have a single course on dental practice management.
And even if they do, it comes at a bad time. It comes when the students are getting ready to write their board. They're trying to think about what their first job is going to be. And all those things. And it's very tough to take people in that situation and really impart a lot about practice management to them. So you have people who typically don't even know the basics who suddenly are business owners.
I think the other thing is that there's a community out there that has realized that overall dentists are easy marks and they almost seek dentists out as being good targets to embezzle from.
Yeah. And we talk about a lot on the show how dentists have a lot of trusted partners around them. Right? Attorneys, accountants, that sort of thing. Wouldn't one's accountant catch something if it was going awry or not necessarily?
Well, that's a great question. And you just hit on, I think, one of the biggest misconceptions about this whole issue. Most dentists think that their accountant is on the front line of their defense against embezzlement and if this was happening, of course, my accountant would find it. The thing that a lot of people don't think about is one of the differences between dentistry and, let's say the corner store down the street is that the corner store down the street has one accounting system that tracks both revenue and expenses.
In dentistry, those two are split. So you have QuickBooks or some kind of accounting software that looks after expenses, and then you have practice management software that looks after revenue. The two of them don't talk to each other.
When the accountants do their work, dentists use this thing called the cash method of accounting. And what the cash method of accounting means is that revenue is counted only when it hits a practice's bank account. In other words, if you were using the other method, which is called accrual accounting, when you do the work is when you earn an income.
But for tax purposes, the IRS allows people to use the cash method, which is simpler and sometimes more favorable to the doctor. And what that means for the accountants is that they don't even need to take a look at practice management software. What happens inside that is not relevant to them. Their relevance starts when money hits the bank account.
So if money is embezzled generally it doesn't hit the bank account. And that just means that it's outside of the viewpoint of the accountant.
Interesting. Yeah. And who have you seen is most likely to be the one stealing from a dentist? You've mentioned office managers, front desk. What about partners? Family members? There's a lot of family members that work in practices.
It could be anybody. And of course, how somebody steals is driven by what their job is in the practice. So, for example, if I'm a dental assistant and I steal. Probably what I'm doing is stealing supplies out of the supply cabinet and selling them on eBay, you know, or maybe the gold jar. So every dental practice has a jar where the old restorations go and it's some mix of scrap gold and other stuff.
And, you know, if I put my hand in and take away a handful of gold, I can go and sell that somewhere. If I am, let's say, a bookkeeper and I'm not involved in the incoming funds in the practice, but I'm the one paying the bills and stuff, maybe I find a way to tamper with that stuff. And if I'm office manager, front desk financial coordinator, then I have access to patient payments or insurance payments, and that's what I steal.
So anybody could do it. And you also mentioned partners. You know, that's one that when I talk to a live audience of dentists, that's one that always gets some surprised expressions, you know, because everybody can understand how an employee would steal. But a business partner, you know, somebody who shares your code of ethics, maybe was your classmate in dental school.
I mean, for that person to steal is almost inconceivable. And yet it happens a lot. Just to give you some numbers, we have typically about 120 active cases. So that's what we're working on today. From that 120, typically around 7 to 10 of those will be cases where the suspect is another doctor. When you think that it's a fairly small percentage of dentists who practice in group practices to begin with, that's a pretty frequent occurrence.
I wouldn't have imagined it would be that high.
It is that high.
So in your work, why do you think people steal in general? Is it a sense of thrill? Is it just that easy? Or do they feel entitled?
I think it's all the things you just mentioned. You know, the short answer is because they can, I mean, theft is, of course, enabled by opportunity. I mean, if there is no opportunity to steal, then there's no stealing. But embezzlers really steal for two reasons… need and greed. Needy thieves are upside down financially. I mean, there's more money going out of their household each month than what's coming in.
And it could be a lot of things driving that. One of the classic cases is somebody who’s going through a divorce. And if you think about the economics of divorce, you start with two incomes in one household and you move from that to two incomes and two households and a bunch of attorney bills that can stretch almost anyone's finances.
So needy thieves are trying to defend the basics of life. They're using the money they steal to pay the rent or the mortgage and buy groceries. And then you have greedy thieves. And they're what you said. They feel underappreciated. A lot of them look at their dentist as being basically a high functioning moron with good hands, and doctor, the only reason you're successful is because I keep your chair full.
And then when people leave it, I collect the money. So they kind of construct in their minds this partnership between themselves and the dentist that doesn't exist anywhere else. And they steal what they think they should have been paid in the first place. So it's an ego deficit, put another way.
Yeah. Yeah, absolutely. So, David, just how prevalent is embezzlement within offices today? You mentioned you're working on 120 cases, but are there any other numbers you can share?
The numbers I'll give you came from a study the American Dental Association did in 2019. And what they did, Corey, was they asked 19,000 dentists have you been stolen from? And I'll start with the good news. 53% of the respondents said no, I don't think so. So the other 47%, of course, said yes they'd been stolen from.
And then the ADA asked them another question, how many times? And now I got kind of interesting. So again, 47% said yes from that 27%, in other words, a little more than half of the group that said yes said once, as far as I know. 11% had been stolen from twice. 2%, three times. And the one that should really make us all scratch our heads for a minute is that 8% of the respondents had been stolen from at least four times.
Wow. And I'm wondering how many of the 53% have been and they just don't know it.
Or I guess how many of them were stolen from and chose not to share that with the ADA, which is the other possibility. And then the other unknown, of course, is how many of these people will get stolen from either for the first time or again in the rest of their careers. If I had to give you my best guess, the chance that a dentist will get hit in his or her career is probably around 70%.
The other thing I'll mention is that there's a very noticeable upward trend in this. The study that I just talked about was done in 2019, and again, 47% of dentists reported that they had already been stolen from at least once. The A.D.A. asked the same question in 2007. In 2007, 35% had been stolen from. Okay, so 35% to 47% over 12 years.
That's a pretty strong trend line. So this is a growth industry.
Yeah, well, it's a good thing we're talking about this now then, David, you know, we've discussed some common signs of theft and who might be apt to do so. But when we come back, I'd like to get into what dentists can put in place to deter theft from happening in the first place. More with David Harris right after this.
I'm Corey Brown and this is Provide’s the Path to Owning It podcast. We're back with David Harris, CEO of Prosperident, to discuss how dentists can avoid embezzlement within their practices. You know, David, after all of this talk, I'm wondering, I'm sure others are, too, who have worked in digital practices, how common this is, which you've kind of told us.
And I certainly was shocked when this happened in a practice that I had worked at previously. So what are some common red flags that you can share that would indicate you might have an embezzlement problem?
The red flags kind of fall neatly into two categories. You have financial irregularities. So that's where the numbers don't add up for some reason. And then you have behavioral irregularities and that's where somebody is acting like they're stealing. So an example of a financial irregularity, Corey, might be when the collections, according to practice management software, don't correspond to bank deposits.
And we know there are some timing differences that make the measurement of that a little bit challenging. But over the long term, if collections according to practice management software, are consistently higher than bank deposits, you may have a problem. Behavioral anomalies are generally a lot easier to spot and categorize when you know what you're looking for. And an example of a behavioral irregularity might be the staff member who never wants to take vacation or the person who arranges their work schedules so that they get some alone time in the practice.
Because thieves typically want to be by themselves when they steal. As far as vacation goes, if I'm on vacation, then I've lost control over how information moves through the practice. A case I worked on quite early in my career was a two-doctor periodontist practice. The thief was a long-time office manager and what happened was she broke her leg skiing one weekend and suddenly Monday morning, for the first time in anybody's memory, she was not in the practice. And about 11 a.m. one of the receptionists came into the senior doctor's offertory took him out of the operating, which was a big No-No in their culture.
And said, Doctor, there's something weird going on here because I've gotten three of these very strange phone calls this morning. Had the office manager been there and those phone calls would have gone to her and it just never would have escalated to the doctor. But he listened to what the receptionist was telling him, and then he called me and it was a significant theft and it all came to light because the office manager involuntarily wasn't there on Monday morning.
So if we're noticing that we have some of these financial and behavioral anomalies in our practice, how do you go about an investigation? Is it something you want to do discreetly, or is it better to do it maybe publicly?
100% it is better to do it invisibly, for a couple of reasons. First of all, everybody I talked to in dentistry right now is asking the same question… Where did all the people go? Everybody's having a hard time hiring. And if you're reading the tea leaves wrongly, which happens sometimes, the last thing you want to do is harass an otherwise good employee over something that turns out to be nothing.
If you make the sort of visible public declaration that I'm having a little bit of a trust issue with you right now, you destroy the working relationship, and especially right now where it's so hard to replace people. You do not want to do that. On the other hand, if somebody is stealing and if they get the idea that they're about to get caught and getting caught means going to jail and all that goes with that.
The list of things that somebody will refuse to do to prevent all that is pretty short. And there have been cases… we weren't involved. But three that I'm aware of where an embezzler actually murdered their dentist. So if you suspect or if you have concerns, what happens next really, really, really needs to be done in secret.
And one of the things I'll mention is that when we do an investigation, it is 100% invisible to staff and we go to a lot of steps to make that happen. But they have no inkling at all that we're taking a look.
And you mentioned earlier, technology changes have helped you probably do that much easier than earlier in your career.
They have. And I’ll let one of our cats out of the bag. What we do typically is we clone somebody’s practice management software. So if somebody is using let's pick a software Dentrix. What my IT guys do is they copy the data files from the practice’s server and they use those to build our own copy of Dentrix.
And we do our investigation in our copy and not the live one in the practice. That entails some work, but it's worth it. You know, it's a whole lot better than us logging in remotely or God forbid, putting people on site.
Yeah. How long does it take you commonly to complete an investigation, would you say?
Ideally about eight weeks, sometimes a little bit faster and sometimes we run into some complications or, you know, we need the help of a third party somewhere and maybe it stretches a little bit longer. But eight weeks is our target. Now, having said that, that's eight weeks from start to our handing somebody the final report. If embezzlement is happening on average, we find it about week four or five.
We let the doctor know and give them whatever help they need in frog-marching the thief out the door. And then we need to go back and finish our work and put together a final report.
Do you find that dentists prosecute when they find the thief in their office?
Our clients almost inevitably do. I think the experience for other people is maybe a little bit different, but we strongly encourage them to prosecute. And secondly, we give them what law enforcement is going to need to do that. You know, one of the things people misunderstand about this problem Corey is some people think that if I go into the police station with my shoe box and I drop it on somebody's desk, you know, and I've got reports from my software and stuff in there that they will solve the crime for me.
They will not. This is a highly technical crime. To conquer it, you really need to know a lot more about dental offices than the typical high school educated detective in the police department knows. And you need to have a reasonable amount of time to sink into this problem. The police have neither of those things. So what happens sometimes you hear in the kind of dental media that it's hard to prosecute this stuff.
For the most part, it's because people go at it the wrong way. When the police get one of our reports… and we get praise all the time from law enforcement who say to us, basically, I wish all the forensic investigation reports I got were like yours because we take dentistry and we downshift it to something they can understand. You know, they have when they finish reading our report, they have a crystal clear picture of what happened.
Let's get two of the bigger questions they are your audience probably wants to know is how much does something like this cost? And I'm also wondering, do you have any or offer any kind of preventative or proactive services for something like this as well?
We do. So cost depends on a number of variables. First of all, how big the practice is, you know, a four doctor oral surgery practice is a little bit more work to look at than a one dentist, one hygienist, general dental practice. Size is an input. The other inputs are the length of time that we're looking at. In other words, are we investigating a year or two years or five years?
Because that also dictates workload. Which type of practice management software has a little bit of impact because some software is easier for us to work with and some is harder and we'll not name names, but those of you who are harder, you know who you are, but as small, like a one dentist, one hygienist practice investigation for a year typically costs about $7,000. If you're a four doctor oral surgery practice that I mentioned, that might be more like 15 or $18,000.
Gotcha. You mentioned preventative services. What does that look like?
It's no different than dentistry. You know, if you're a dentist and I say to you, Doctor, I'd like to spend the least amount of money in my lifetime on my teeth. How do I do that? What your answer to me would be is, Well, David, you should become really good friends with your toothbrush and your floss and you should see our hygienist every six months, because the cost of doing those three things is a whole lot less than the cost of you neglecting them and me having to fix what you break.
The exact same thinking applies here. Most embezzlement is enabled or discovery is postponed because of system failures. And if somebody can get there first and fix the broken systems, then that's a whole lot easier and cheaper and less invasive than us going around with the broom and the dustpan after and cleaning up the mess. So prevention is absolutely key.
And we offer a service called Owner Proactive Strategies or OPS, where we find the systemic weaknesses. And Corey, we crawl over a lot of areas in a practice when we do this. Everything from how pre-employment is screening is done because that in general is a very poorly done phenomenon in dentistry.
Especially now when people are hard to come by, like you mention, I would imagine.
Yeah, that that's just exactly the excuse for people to skip over the step. I'll give you just a slightly chilling statistic. 70 million Americans, which equates to one in four adults, has a criminal record. And yet the majority of dental practices do not do a criminal record check. There are lots of other things, you know, drug testing and talking to former employers and so on.
But one thing we help practices do is build a good pre-employment screening process that helps keep some of the rotten apples out of the barrel. We look at things like division of duties and security settings and practice management software. You know, we crawl over a lot of systems, but the place where we really get accolades for what we do in prevention is we help doctors understand how to oversee their practices, and we'll sit there and screenshare with them and look at their practice management software together and say, okay, so let's build your end of day checklist for what you do and what your office manager does.
And then let's build your month end checklist again for you and for the office manager. We'll show you how to print the reports and how to interpret them and what constitutes an outlier. And they all say the same thing. Thank you, nobody shows me this. There's nowhere to learn this. It's wasn't taught in school. The doc I bought the practice from had their own system, you know, that they came up with in 1987 when they were a manual system and there's a spouse was their office manager.
You know, that really didn't fit my context. There's nowhere to learn this.
And from all the practices that you find do have an embezzlement issue. Would you say that a lot of them don't have those types of things in place, their systems like end of day checklist, or do they have those things? And thieves are just getting more and more adept at finding loopholes.
We see some really clever thieves and we see some really ordinary ones. When you have an unsupervised practice, what I tell dentists is the dumbest, laziest thief on the planet can successfully steal from you. There's an inherent tradeoff between controls and efficiency. If you really wanted to have the completely embezzlement proof practice, that would take all your time and you'd never get to treat a patient.
So we live in a world of compromise where if we can implement something that would take 10 minutes a day and maybe an hour to an hour and a half at month end for a dentist, they can probably raise the bar high enough that 80% of thieves can't get over it. To me, hat's a pretty reasonable way of protecting yourself.
Yeah, absolutely. And David, just to kind of summarize our conversation a little bit, I'd love to know what's your best piece of advice for our listeners if they think they might be facing internal theft?
Call an expert now, and don't make the mistake that I see a lot of people making of confusing somebody who knows 20% more than they do with an expert. A lot of people in this situation will turn to somebody they know who they think might be able to help them, and maybe it's their accountant or their attorney or trainer for their practice management software or maybe a consultant.
And those people are all experts, but it's something else. There are legitimate experts in dental forensic investigation. We're the largest company in that field, but there are other people who do that kind of work as well. And you need somebody from that spectrum. Yeah. One of the other things people do is they will go to a forensic accountant, and I'm a forensic accountant, but I'm a dental-specific forensic accountant.
There are generalist forensic accountants who don't know the first thing about your practice management software or how dentistry works, or the interplay between insurance and patient payments, and that the learning curve for them is just so steep. And of course, it's billed to you hourly, so you're going to end up paying somebody like that a whole lot of money to learn enough about your business that they can do theirs.
Yeah, and you have, I should mention many tools that dentists can reference to help them if they are facing these issues. We mentioned earlier, you've author two books on embezzlement, the most recent of which Healers versus Stealers How to Outsmart the Thief in Your Dental Practice. And it was just released in August of this year. But can you share maybe what your favorite excerpt from that book and where our listeners could get a copy?
Sure. It's available on Amazon and through a lot of booksellers. One thing I spend a fair amount of time on in the book is financial control systems, and I make it a whole lot easier than it otherwise would be for dentists to keep an eye on their money. This is the part that I see not generally done well by practicing dentists.
And as I mentioned, it's not taught anywhere. I'll give you an example, Corey, of the kind of thing that I talk about there. One of the mistakes that I see people make a lot is they spend a fair amount of time looking at their day end report, but they don't ensure what I call articulation. And I'm using that word deliberately because every dentist understands it in a different way.
But the way articulation works is let's say you're a practice owner and your office was open 16 days this month and in your left hand you have 16 day end reports that were generated at the end of each of those days. And in your right hand, do you have a month end total report. One of the things that should happen is that if you add up the fees and adjustments and payments from the 16 daily reports, they should equal exactly what the month end report says.
If they don't articulate, then what happened is somebody came in on a Saturday and they did a bunch of stuff they didn't want you to see, and then they shredded the report from Saturday, so you don't even know it exists. That's the kind of concept we build in the book.
And the good news about that calculation is you don't have to be a dentist to do it. That's something that your external bookkeeper, your CPA firm, if they offer that service, your kid in college could do for you. It doesn't have to be done by the doctor personally, but it really needs to be done. And that's just a way of ensuring that you have seen every transaction that you're supposed to see.
David you've given us so many awesome insights today. If our listeners would like to work with you to help sniff out a suspected thief, what's the best way for them to get a hold of you and the Prosperident team?
They can call us at our toll free number, which is 888-398-2327. Or they can go on our website which is www.prosperident.com. There's a contact us button there and they can fill in a form and typically somebody will get back to them within a couple of hours.
David That's great. Thank you so much for shedding light on this very important topic and arming our listeners with tools and advice to help curb this problem before it starts. We really appreciate your time.
Thank you for having me on your great show.
Thanks for joining us. Because you've listened to this whole episode, we assume you were entertained. At the very least, you learned something new. If so, leave us a review on Apple Podcasts or Spotify. Have a topic you'd like to discuss in a future episode? Drop us a line in the comments section or send us a message on social media.
If you're ready to take your practice ownership dreams into your own hands, be sure to visit GetProvide.com pre-qualify and browse our practice marketplace or check out our news page for more helpful resources. The Path to Owning It is brought to you by the team at Provide, and it's produced by Podcamp Media, branded podcast production for businesses. PodcampMedia.com. Producer Dusty Weis. Editor Emily Kaysinger.
For Provide, I'm Corey Brown. Thanks for being on the journey with us.
Provide is a division of Fifth Third Bank, National Association. All opinions expressed by the participant are solely their current opinions and do not reflect the opinions of Provide, its affiliates, or Fifth Third Bank. The participant’s opinions are based on information they consider reliable, but neither Provide, its affiliates nor Fifth Third Bank warrant its completeness or accuracy and should not be relied upon as such. This content is for informational purposes and does not constitute the rendering of legal, accounting, tax, or investment advice, or other professional services by Provide or any of its affiliates. Please consult with appropriate professionals related to your individual circumstances. All lending is subject to review and approval.