Most physicians want to focus on practicing medicine and providing quality patient care. They also want to run a successful medical practice, of course, but many prefer to entrust day-to-day business operations to front-office employees—with little or no oversight. Unfortunately, this may leave a practice vulnerable to fraud and significant financial loss.

Practice embezzlement has been on the rise over the past couple of years, according to the Medical Group Management Association. Startlingly, three out of four physicians will suffer some financial loss from employee dishonesty over the lifetime of their practice. To help prevent and detect fraud, medical practices should implement regular audits and internal controls to monitor and guide proper employee conduct.


Identifying the factors that provide the opportunity for fraud to occur is an important part of preventing fraud. According to an Association of Certified Fraud Examiners survey, these factors include:

– Ability to override existing internal controls

– Lack of management review

– Limited number of competent personnel in oversight roles

– Many medical practices are short-staffed, requiring employees to take on a wide range of responsibilities. From the handling of monies from co-pays and insurance reimbursements to processing payroll and reconciling bank accounts to having regular access to cash boxes, there are a number of ways for employees to misappropriate funds. Proper controls are needed to prevent employees from voiding or manipulating transactions such as a charge after it’s posted to the system. It’s also important to properly separate accounting functions, particularly those dealing with cash.


In addition to the above, gaps in the billing system can create openings for fraud such as deletion of co-payments or other patient payments. Additionally, many times cash drawers are unlocked or not fireproof or, even worse, the key to the box is hanging next to the front desk. Below are other common areas that often lack controls and oversight, allowing employees to steal from a medical practice:

– Co-payments aren’t posted to the system at the time a patient checks in or leaves the practice

– Patients are told to pay a higher amount that isn’t consistent with what’s entered into the system

– Cumbersome cash receipt processes

– Credit card machines aren’t closed out by management, allowing employees to make adjustments to their personal accounts

– No payment reconciliation process

– Payments are posted prior to deposit at the bank

– Deposits are made only weekly or as needed

– No cash is posted or deposited the last two days of the month


There are a number of standard procedures you can implement to help your medical practice run effectively and efficiently, including:

– Issue receipts for all payments received.

– Make sure the front desk performs reconciliation prior to close for the day.

– Close out the credit card machine daily, with manager oversight to approve refunds or voids.

– Keep cash boxes in a fireproof safe overnight, and store the key outside the front-office area.

– Define discounts and co-pay collection procedures.

– Implement access controls, such as codes for receipt modules on billing systems.

Regular testing and auditing of internal controls is important to ensure they’re working. Testing should include a review of the procedures related to payments or cash receipts and should follow payments through to bank deposit. It should include the following steps:

  1. Select a sample of receipts.
  2. Test to determine if posted to the patient’s account.
  3. Verify the lag.
  4. Confirm that the amount of the daily deposit matches the dollar amount received per the receipt book.
  5. If the patient receives a discount, confirm that the amount matches the policy.


There are several ways to mitigate fraud in a medical practice. First, it’s important to involve more than one employee in the accounting process. Another important approach is to review a random selection of bank reconciliations and bank statements every few months, ensuring all receipts are generated from the billing system and each is numbered.

Next, the cash till or drawer should be reconciled at the end of each shift. To do this, one person reconciles the account and places it in the safe. The next day another employee can verify the amount and be responsible for depositing it into the bank, using either a bank courier or desktop depositing.

Finally it’s a good idea to implement a process to reconcile the amount posted in the system with the amount deposited in the bank. One way to encourage the consistent integrity of the process is to implement randomly timed surprise audits.


For questions about how to identify improprieties and misconduct at your practice and determine the best internal controls to address these risks and prevent future fraud, contact your Moss Adams health care professional.



Bacall Conniff and Associates Review: The Background of Restaurant Industry

The food service industry has been around for a long time without us realizing that the evolution of this type of business greatly affects everyone over time. The restaurant industry creates a revolutionary impact on industrialization and in the economic system of the world.

In the past, people plant their own food and raised animals for meat. The growth of cities and towns correlates with the birth of restaurants. When people became educated and learned various skills to earn a living, it became unavoidable for them to assign the duty of cooking meals to a person or an enterprise.

The restaurant has boomed because people want to avoid the strenuous task of food preparation all day long. There were menus or options to choose from generally served and eaten on the premises but they also offer take-out and food delivery services.

The remarkable growth of restaurants, like in Singapore, encouraged many people to invest in this kind of business, thus making food choices much more diverse. The success of hamburger and doughnut chains and now, even the simple beverage like coffee caused the expansion of restaurant chains worldwide. The birth of the restaurant affects the lifestyle of many people and the civilization’s economic texture. The increasingly hectic lifestyle of people working makes cooking at home a challenge causing them to order take outs.

A specific type of restaurant such as fast food restaurant, also known as quick service restaurant (QSR) has risen in the past decade offering quick, convenient and inexpensive meals. This commercial establishment’s main goal was to make money ignoring the proper way for nutrition. Some of the foods offered by these commercial establishments are of little nutritional value and often high in fat, sugar, and calories.

But due to the growing wellness and fitness industry, many restaurant chains now started offering healthy alternatives to their customers. This shows that restaurants will surely adapt to changes along with the customers food preferences.

Bacall Conniff and Associates provides accounting and financial services to the restaurant industry making it competitive in the world economy.

Aboriginal Law And Advisors Group – Bennett Jones

Our Aboriginal Law Group helps project developers navigate the regulatory process in securing approvals for major energy development projects, including consulting and negotiating with Aboriginal groups and other stakeholders. We draw on our top-tier, cross-departmental expertise in the energy, environmental, corporate commercial, regulatory, litigation and tax arenas in shepherding significant projects through to fruition. We structure and negotiate commercial agreements for projects involving aboriginal rights and interests, as well as debt and equity financing arrangements for projects on aboriginal lands or with aboriginal participation.

We understand the risks associated with Aboriginal issues in the context of significant energy development project approvals and work closely with our clients to devise an exposure management plan to identify and manage potential litigation and other issues both pre- and post-closing, including compensation, royalty, surface rights and land access issues. Our unparalleled experience with major development projects enables us to forecast outcomes with a high degree of accuracy.

Select Experience

Mackenzie Valley Aboriginal Pipeline Group regarding the multi-billion dollar Mackenzie Valley Pipeline Project, in connection with the negotiation and structuring of commercial agreements including ownership agreements among various Aboriginal groups and various development, operating, shipping and financing agreements with Imperial Oil, ExxonMobil, ConocoPhillips, Shell and TransCanada Pipelines.