Protecting Your Practice From Fraud

Billing and insurance fraud can be crippling to a dental practice. Even more alarming, it only takes one malicious employee to bring down an entire business. Learning how to protect your practice from fraud can help keep you safe from a host of personal and professional damages.

Fraud Prevention

Fraud is defined as "making false statements or representations of material facts in order to obtain some benefit or payment for which no entitlement would otherwise exist."

Here are some things you can do to protect your practice from fraud:

  • Delegate tasks related to money to different employees. For example, put one person in charge of submitting insurance claims and another person in charge of collecting and processing those payments.

  • Have all claim submissions reviewed by a second employee. A common case of fraud involves performing one procedure while filing a claim for a more expensive one.

  • Using a practice management system can help prevent fraud by utilizing built-in reporting features and automated claim submissions.

  • Write up a fraud contract outlining what constitutes fraud and the protocol to be followed in order to avoid it. Have all employees read, understand and sign the contract.

  • Compare your office treatment records with your financial and insurance records on a weekly basis to ensure everything matches up.


Consequences of Fraud

Fraud drives up the cost of dental care for your patients, which can have a negative effect on the number of customers that come through your door. Protecting your practice from fraud means protecting your bottom line.

A conviction of fraud can also lead to:

  • Hefty fines
  • Serious prison time
  • Bad publicity
  • Damage to your personal and professional reputation
  • Your practice having to shut its doors


A Standard of Ethics

Becoming an ADA member is a good first step in protecting your practice from fraud. But ultimately, the responsibility lies with you and your fellow employees.

Kool Smiles adheres to the Principles of Ethics and Code of Conduct set forth by the American Dental Association. The ADA takes a hard stance on being truthful and fair to all patients and member practices are upheld to these standards. Kool Smiles also strictly abides by the guidelines set forth by HIPAA to protect patients' privacy.

To learn more about Kool Smiles, visit the Kool Smiles website!

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Sources:
Slide Share: http://www.slideshare.net/dentistryinfo/fraud-and-abuse-in-dentistry
ADA: http://www.ada.org/en/member-center/join-or-renew-ada-membership/
Prosperident: http://www.prosperident.com/Documents/Articles/DentalOfficeFraud2.pdf

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