THE EFFICIENT OPHTHALMOLOGIST

Physician, protect thyself

Some advice on insulating your practice from employee thievery.

By Steven M. Silverstein MD, FACS

By nature, we physicians are a trusting people. We trust that our staff will behave like business owners, with the practice’s best interests at heart.

If that were only true, all the time.

In one survey, 83% of the nearly 800 medical practices that responded reported internal embezzlement or theft.¹

EXAMPLES TOO CLOSE TO HOME

My father is a plastic surgeon, and his group had one of the first surgery centers in Oklahoma City. One Saturday several years ago, the silent alarm was triggered, and the doctors, administrator and police were notified. By the time they arrived, the criminal was gone, and the only missing items were the narcotics in the pre-operative area. A review of the motion detectors and their activation times revealed that the criminal knew exactly where the narcotics were stored, strongly suggesting that the perpetrator was either a staff member or someone very familiar with the practice’s layout. After a thorough investigation, the criminal was apprehended and arrested; it was the security guard who had “protected” the facility for years.

In my own ASC two years ago, a break-in occurred overnight, and though thankfully none of the expensive medical equipment was stolen, the criminals took a flat-screen TV and recording and computer devices.

Necessity has little to do with in-office crime. Offenders revealed in interviews that they felt their actions were justified since the doctors collected plenty. Taking small amounts of cash or material goods would not hurt the practice’s income, they reasoned.

Except small is relative. In that survey, 18% of the respondents reported losses of more than $100,000; 50% reported losses between $1 and $50,000.¹

OBJECTS OF TEMPTATION

So what are the “take me, take me” obvious objects of value? Petty cash is an accessible target and not easily reconciled in the revenue reports. Another: Office supplies. Sometimes, even the most loyal and trusted employees somehow convince themselves that taking these items home is not stealing. And how about postage meters? Who regulates or has access to this equipment, and how would we know when someone uses them for personal use?

And your waiting room: What valuable items are in there so that an unauthorized admirer could just “walk off” with one?

As for your clinic’s valuables: Where is Botox stored in your office? More often than not, it is kept in a refrigerator in the nurse’s station, or sometimes in the lunch room. Staff taking vials of Botox for personal use or to sell to friends is huge, and when quantities are sizable, loss may be difficult to recognize.

For practices that dispense contact lenses or especially, have an optical shop, petty theft is nearly guaranteed. Typical display cases are usually open-air, so that patients may browse and try on different frames.

PREVENTING THEFT

• Clearly define the no-tolerance/prosecution policy in your practice employee manual, and review it with all employees — especially employees — and have them sign the policy for your records. Sometimes, knowing the potential consequences to such behavior serves as a deterrent in its own right.

• Run a comprehensive background check on all staff, including those who came to you on the recommendation of another administrator or colleague.

• Lock up everything of value, and ensure that a regular inventory is taken (easy today for retail using bar code scanners, which cost $100).

• Install discreet cameras in sensitive areas which, similar to home security systems, digitally record a week’s worth of data, and “dump” the oldest recordings.

• Create a system of checks and balances in the practice: require two people to sign off on appropriate matters such as accounts receivable and accounts payable. This way temptation is deterred.

• Limit access to items such as office supplies, Botox, postage and copy machines, requiring a personal code or password so that utilization may be tracked, similar to systems in use by the legal profession.

• Change keys and passcodes each time an employee either leaves or is terminated from the practice.

• Never have the same person collect money and make deposits.²

• Mail your bank statement to another address.²

And one last thought: Insurance. You can buy dishonesty insurance.³ It covers you against losses caused by staff who handle your money. You can get enough insurance not just for what is lost, but also to cover the investigation’s expenses. OM

REFERENCES

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.