Monthly Archives: May 2013

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Recently, we worked with a practice that had been victimized severely by internal theft.  This theft was facilitated by the practice's failure to take advantage of EFT of payer reimbursements -- instead receiving checks from many of their contracted plans. The physicians had trusted the practice manager when she said that EFT had been elected whenever available (naturally, embezzlers always rely on goodwill from their employers!).  But, had the physicians been on top of HIPAA rules regarding EFT -- intended to standardize and encourage EFT by January, 2014 -- they might have been more skeptical of the manager's claims that EFT either "wasn't available" or "was in process." Checks received at your office can be a temptation for would-be embezzlers.  It's unfortunately not all that difficult to deposit checks made out to your practice to a different account (ATMs, for example, can be a way to deposit checks to an account with an entirely different name -- and, of course, some embezzlers are crafty enough to set up a new account for themselves with a similar name to your practice's). It's rare that a payer won't pay your practice electronically, direct to your account, if you ask them to -- and, in a few short months, there will be a standard for all payers to pay this way.  Be skeptical if an employee claims that it is difficult or impossible to avoid receiving checks in the office.  Even if you prefer to receive checks -- say, because you're concerned about matching up advice notices with payments, or because you're worried about direct deduction of payment retractions or other unexpected adjustments -- remember that a lockbox service at your bank can help keep temptation (and access) at bay.

Last week at the Florida MGMA conference, I had the pleasure of presenting to their lively group on a decidedly unpleasant subject: embezzlement and medical identity theft at physician practices.  While internal theft is such a disillusioning topic -- embezzlement has frankly become part of far too many of our engagements recently! -- presenting ideas for preventing and spotting it to motivated practice administrators does at least have the upside possibility of helping administrators thwart would-be criminals before they get too far with their nefarious intentions. In fact, I was reminded by a participant that the very best way to stop an embezzler is not to hire him or her in the first place!  When I put up a slide showing article clips and pictures of medical practice employees who'd recently been arrested and charged in FL for stealing from their organizations, one of the attendees raised her hand to say she'd actually interviewed one of them recently for a job.  Thankfully, this administrator had noticed that reference checks were fishy -- references were unwilling to discuss the candidate for the most part -- until one person simply revealed, 'check arrest records.'  This was all the clue the savvy administrator needed to dig deeper and find out what she needed to know to avoid hiring someone who'd recently been fired for stealing. It's stunning to realize that that the candidate was apparently interviewing for the job while out on bail (and charged with stealing over $1MM over several years from her prior practice), without, of course, admitting this fact.  Kudos to the administrator for persisting when references were reluctant to talk.  There is a common misconception that it is better to say nothing than to tell the truth of why an employee was dismissed -- even when not revealing the reason exposes others to potential harm.  (What if the employee had been dismissed for stealing patient identities?  Not alerting other practices to the risk could jeopardize patient information at the next practice that hires her -- and even expose the first practice to liability for not fully responding to the

A friend of mine recently shared a pretty disappointing experience she recently had with her primary care practice when she sought treatment for a painful, infected spider bite.  Or, perhaps I should say, an experience she had with her former primary care practice, since the practice refused to see her -- stating that she was no longer a patient because she hadn't been in for a visit for three years, and therefore "couldn't be seen" until she scheduled a new patient wellness exam. My friend was told that this was the policy of the IPA that the practice was part of -- and that she had "no choice but to go to urgent care."  In this context, urgent care was presented to my friend almost as sort of a downgrade -- like, "go wait in line at urgent care." It felt to my friend -- who was already a bit nervous about her injury -- like the practice really didn't care about her at all. Luckily, the urgent care center they recommended was friendly and appealing, and a doctor saw her quickly and treated her infection (which turned out to be spreading alarmingly fast) carefully and attentively.  Not surprisingly, the doctor at the urgent care center was happy to let her know that he could also act as her PCP -- and, my friend is considering making the switch, even though she had been with her prior practice for nearly 20 years! Why did the PCP risk losing such a valuable patient?  (Besides being a long-term patient herself, my friend has two teenaged children who will soon need to graduate from their pediatricians.  So, that's three patients potentially sacrificed for lack of a recent wellness visit.  Moreover, my friend is the ideal patient for primary care: pays her bills at time-of-service and is always diligently compliant with advice.) One guess is that the IPA doesn't want to miss out on the chance to bill for a new patient wellness visit at a higher rate.  (The practice may not even realize this is an underlying motivation.)  But, is that $50 or