How Secure is my Practice Management Software?


Editor’s note — this article is an extract from the upcoming second edition of David Harris’ book Dental Embezzlement; The Art of Theft and the Science of Control, expected to be available in 2021.


A couple of the most frequently asked questions by doctors regarding practice management software are:

  • Is there a brand of practice management software that is better at protecting a doctor against embezzlement?
  • What is the most secure software?

This is like asking if one hammer is safer to use than another. All hammers have the potential to be safe if used properly, and the potential to cause grievous harm if they are not.

How is Practice Management Software Built?

Let’s start by looking at your software in a way that is slightly different than what you are accustomed to.  Your practice management software really consists of two parts.  There is a relational database that contains “data tables” that contain all the information on your practice.  Data tables include patient master information such as name, address and phone number, as well as treatment records, receivables balances and so on.  The database programming languages used are commercial programs made by big companies like Microsoft and Oracle and licensed to the company that makes your practice management software.  The most common database language used in practice management software is called SQL, which stands for Structured Query Language.

The second part of practice management software is an interface, or “front end” that allows you and your staff to interact with the database in an organized and hopefully user-friendly fashion.

Data Integrity

I think that what is sometimes behind this question is fear on the part of the dentist posing the question that a clever staff member could somehow bypass the front end of the software and directly make edits to the database, or can edit the audit trail to erase evidence of wrongdoing. 

I’ll put your mind at ease on this one.  Reading information from the database without using the practice management software’s interface isn’t terribly hard for someone with a computer science background and some database skills.  This is something that we do on a fairly regular basis in the course of our investigations.

However, editing the data in the data tables is a much more difficult undertaking. Without dragging you into a lot of detail about database architecture and checksums, I can tell you that doing this is very difficult in any modern practice management software.  The end result of someone trying is likely that, the next time someone tries to start your software, it will report a database error and will require some resuscitation to run. 

I’m not saying that editing your data in some other way than using the interface can’t be done, but this would take someone with PhD-level computer knowledge.

If the Integrity of the Database is Secure, Where Does the Danger Come From?

You’ve heard the saying from gun advocates that “guns don’t kill people; people do.”  I’ll say the same thing here.  Most embezzlement takes place not because of inherent weaknesses in practice management software, but because human practice owners fail to apply sufficient supervision and common sense to their practice management software.

Unfortunately, there is no such thing as embezzlement-proof software. All practice management software is designed with built-in safeguards, but then most practice owners neutralize many of the security features.  There is always an inherent tradeoff between controls and efficiency.

For example, it is possible to set up practice management software so that the practice owner is the only person permitted to authorize credit adjustments to be made to patient accounts. While, in theory, this is safer than allowing staff members to make adjustments without the doctor’s approval, it is operationally cumbersome to have staff continuously interrupting the doctor when transactions need to be authorized. Most offices find the safest options unwieldy and end up deliberately bypassing some of the built-in safety features of their software for the sake of convenience.

Maddeningly, when new practice management software is installed, typically, the default setup disables many of the security features available, and to enable these features requires specific action on the part of the practice. The reason that the companies that make the software take this approach is understandable; with unfamiliar practice management software, higher security settings inevitably prompt more calls to the software’s support line. When someone new to a particular software discovers that something that they are trying to do is blocked, the next step usually is to call the software’s technical support to ask for help. To reduce user frustration and manage support costs, software companies normally turn off many security features in the default setup.

So let’s start treating our practice management software as the vital repository of data that it is. Having that mindset will offer far more protection than any built-in security feature in software.

Idaho Patient Charged with Stealing Relative’s Identity to Get Dental Work

Editor’s note — this is why your office’s practice should be to check identification on every new patient.

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IDAHO FALLS — Deputies say an Idaho Falls woman stole a family member’s identity and racked up several thousand dollars in medical debt.

On Aug. 18, the Bonneville County Sheriff’s office received a call from a woman who had been served papers saying she had been sent to a debt collector due to unpaid dental bills, according to an affidavit of probable cause obtained by EastIdahoNews.com. The woman told deputies she suspected that her relative, 50-year-old Toni Jo Lepper, stole her identity to apply for credit at a dentist’s office.

The victim reported that the dentist’s office would not say who applied for over $3,000 in credit in her name back in 2016. While speaking with deputies, the victim said the dentist’s office admitted to never seeing her or having the victim as a patient.

The family member said Lepper has a history of taking family members’ money and stealing their identity to open credit cards. The relative also told investigators that in 2016, Lepper drained her bank account when she stole her identity.

Detectives spoke with Lepper on Sept. 4 about the alleged opening of the account.

“She stated, ‘I needed teeth,’” a detective wrote in the probable cause. “She later explained it was for dentures.”

Lepper explained to detectives she added her family member to the account without permission because the dentist would not give her credit herself. She also told investigators she knew it was wrong but things “got out of control,” according to court documents.

The reported $3,000 bill was sent to a former address of Lepper’s and never paid. It is unknown if the relative ever got a bill or even knew about the account until this summer.

A warrant was issued for Lepper’s arrest and she was charged with felony grand theft by larceny, embezzlement, extortion or by receiving stolen goods. Law enforcement arrested Lepper on Friday then booked and released her from the Bonneville County Jail.

A preliminary hearing is scheduled for Nov. 13 at the Bonneville County Courthouse. If convicted of the felony charge, a judge could order Lepper to spend up to 14 years in prison and pay a $5,000 fine.

While Lepper is charged with a crime, it does not automatically mean she committed the crime. Everyone is presumed innocent until proven guilty in a court of law.

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Content retrieved from https://www.eastidahonews.com/2020/10/woman-stole-relatives-identity-to-pay-for-teeth-deputies-say/

MN Sentenced for Stealing $120k

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Sandra Kelley

WALKER — A 61-year-old Backus woman pleaded guilty to embezzling over $100,000 from a Pine River dental office.

According to court documents, Sandra Jean Kelley said she stole the money to support her gambling and shopping habits.

Kelley was convicted and sentenced Monday, March 15, in Cass County District Court on felony theft of diverting funds from Pine River Dental Arts. Kelley, who was charged Sept. 25, 2020, pleaded guilty to the theft before being sentenced. Judge Jana M. Austad ordered a stay of imposition on her sentence, which includes Kelley serving 60 days in Cass County Jail, being placed on supervised probation for five years and paying a $795 fine.

Kelley has until March 29 to report to jail and, once she has served her 60 days, the conditions of her supervised release include not having contact with the victims, not possessing firearms or ammunition, not voting and she must complete a gambling assessment.

According to the criminal complaint, the CEO of Pine River Dental Arts discovered discrepancies leading her to believe Kelley, the former office manager, mishandled company funds. When Kelley was employed, she was the only employee who oversaw the office financial duties, including payroll and accounts receivable.

A Cass County sheriff investigator spoke with Kelley, who admitted she stole from her former employer, that it had been going on since 2013 and she did it to support her gambling and shopping habits. Kelley stated she paid her personal credit card with company funds.

The CEO claimed Kelley took extra hours through payroll and she took cash from the company account for personal use. The CEO reported that during the COVID-19 pandemic office shutdown, she began to examine the business’ records and discovered that between Oct. 9, 2017, and March 31, 2020, Kelley used the corporate checking account to pay $84,633.08 off her personal credit card, the complaint stated. She also discovered Kelley paid for her personal cellphone bill with a corporate credit card on March 30, 2020, in the amount of $852.24.

The CEO reviewed the payroll records and compared them with office records and discovered that between Sept. 24, 2015, and March 9, 2020, Kelley overpaid herself $44,587.65, the complaint stated. The CEO said after comparing business records with cash deposits at the bank, that between Sept. 24, 2015, and March 31, 2020, Kelley took over $80,878.16 in cash.

The complaint further stated Kelley’s daughter-in-law also worked for the business from 2013 through 2019 as a patient coordinator. The CEO reported records showed Kelley overpaid her daughter-in-law as an employee by $27,908.91 between Sept. 24, 2015, and Sept. 5, 2019. Kelley asserted her daughter-in-law was completely unaware that she modified her payroll. The daughter-in-law reported she had no idea anything was wrong with her paychecks.

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Content retrieved from: https://www.brainerddispatch.com/news/crime-and-courts/6686421-Backus-woman-admits-to-stealing-from-former-employer

NY Woman Gave Illegal Discounts to Family

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Vilma Nokaj

For family and friends of Vilma Nokaj, going to her dental office was good for both their teeth and their wallets, according to police.

The Mahopac resident was arrested on Tuesday for allegedly giving illegal discounts worth $8,200 to eight family members and friends at the Southeast dental office where she worked, state police said. Nokaj, 41, allegedly discounted those accounts from January 2014 to August 2014, police said.

Nokaj was charged with third-degree grand larceny and first-degree falsifying business records, both felonies, and third-degree forgery, a misdemeanor, police said.

She more or less concurrently made a complaint to police alleging sexual harassment on the part of one of the dentists at the practice.

She was arraigned in Patterson Town Court and released. The District Attorney’s office determined that they did not have a good faith basis to proceed with the prosecution.

Ms. Nokaj subsequently sued her former employer, North East Dental Management, LLC, for discrimination and retaliation. After spending several years in the court system, this case was dismissed in December 2019.

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Prosperident Webinar October 22 — the Million Dollar Club – Meet Embezzlement’s Elite

Five investigators, five great stories

Your hosts Amber Weber and David Harris welcome special guests Scott Clifford, Tony Ulbrandt, Pat Little, Sonya Hudson, and Kelly Paxton to this webinar.

The guests, who are all experienced Prosperident fraud examiners, talk about their most noteworthy embezzlement files.

If you want to check out other webinars that we have done, they are all available here – https://www.prosperident.com/prosperident-webinar-series/. Or if you prefer to receive content in podcast format, Prosperident’s The Dental Practice Owner’s Podcast is now available on Spotify, TuneIn and iHeart Radio. You can subscribe using one of the buttons below.

Prosperident Pulse #99 October 2020

Want to receive our newsletter automatically each month?

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October 2020
Next Webinar October 22!
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This month’s webinar promises to be particularly interesting. The topic is The Million Dollar Club – Meet Dentistry’s Elite.
David, Wendy, and Amber will be joined by some Prosperident investigators who will talk about some of their most interesting cases, including thieves who took over a million dollars from their dentists.
The webinar takes place Thursday, October 22, at 8:00 pm Eastern / 5:00 pm Pacific.
To register, click HERE.
If you want to catch up on our previous webinars (we had some great topics like Forensic Hiring and
Steal and Conceal; What Serial Embezzlers Can Teach Us), you can access them at THIS LINK.
PACE CE credit is available.
We look forward to having you back in our audience!
A Minute with Scott Clifford
Scott is one of the three people at Prosperident to hold the title Supervising Examiner. This means that Scott has that combination of intelligence and tenacity to put him at the top of his field. Let’s hear what Scott has to say about practice management software.
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Click HERE to play the video.
Did you miss a previous newsletter? We archive them HERE.
How Big is the Embezzlement Problem?
Over the next few months, we are featuring excerpts from the upcoming second edition of David Harris’ book, Dental Embezzlement; the Art of Theft and the Science of Control.
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The most recent broadly-based survey of embezzlement was performed by the American Dental Association’s Center for Dental Practice, which was published in 2019. In this survey, 19,991 dentists were polled, and the astonishing result was that 48.64% of those who responded confirmed that they had been victims of embezzlement.
It didn’t stop there. As can be seen from the graph above, almost half of the dentists who reported being embezzled disclosed that they had been victims more than once, with 9% of respondents confirming that they had been victimized four or more times.
Something to Talk About…
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I’ll confess to being a news junkie. I’ve always been interested in what is going on in the world.
Lately, my interest has faded. The COVID numbers, which people watch in the way they would look at baseball scores in other times, and the decidedly nasty turn that politics has taken, have made the news far less appealing for me than it once was.
However, I saw an ad a few days ago that gave me pause. The essence of the ad was that if the impact of the virus was that you were stuck at home, that meant that you have a home. If you are bothered about wearing a mask when buying groceries, that means you have money for food. The message was that a bit of adversity should not make us oblivious to the blessings that we have.
As I write this, two of our valued team members, Scott Clifford (profiled in the left column) and Rose Clifford, are on evacuation alert due to wildfires near their home in Northern California. This is the second time for Scott and Rose in the past two years – the 2018 Camp Fire came very close to them, and Scott’s parents lost their home in that fire.
Unquestionably, the virus has impacted both dentists and those who provide goods or services to dentists adversely. I know that Thanksgiving isn’t until next month, but as the ad suggested, let’s be grateful for what we have and give some thought to those less fortunate.
Sincerely,
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David Harris
We are Prosperident, Dentistry’s Embezzlement Experts
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How Big Is the Embezzlement Problem?

We are featuring some excerpts from the upcoming second edition of David Harris’ book Dental Embezzlement; the Art of Theft and the Science of Control.


Embezzlement has been around since the beginning of recorded history. The Code of Hammurabi, the law code of the Mesopotameans, is most famous for its “an eye for an eye” provision, but also specifically addressed embezzlement, as did the legal code for Ancient Egypt.

The earliest record that I can find of embezzlement in a dental practice was in 1857 (which, by the way, also involved a murder). When you consider that the world’s first dental college, the Baltimore College of Dental Surgery, admitted its first class in 1840, it didn’t take long for this problem to emerge.

Former Federal Reserve Chairman Alan Greenspan said this about embezzlement:
“Corruption, embezzlement, fraud, these are all characteristics that exist everywhere. It is regrettably the way human nature functions, whether we like it or not… No one has ever eliminated any of that stuff.”
While measurement issues make the answer to the question of prevalence in dentistry somewhat elusive, a comparison of surveys taken of dentists over time shows that the problem is growing.

The most recent broadly-based survey of embezzlement was performed by the American Dental Association’s Center for Dental Practice, which was published in 2019. In this survey, 19,991 dentists were polled, and the astonishing result was that 48.64% of those who responded confirmed that they had been victims of embezzlement.

It didn’t stop there. As can be seen from the graph below, almost half of the dentists who reported being embezzled disclosed that they had been victims more than once, with 9% of respondents confirming that they had been victimized four or more times.

How common is embezzlement?

If we simply multiply the number of dentists in each frequency category by the minimum frequency (i.e., 27% x 1, plus 11% x2 and so on), we can determine that, for every 100 dentists, there have already been at least 91 embezzlements that have taken place.

In comparison, a 2007 American Dental Association survey determined that 35% of the respondents had been victims , so in the 11 years between the two surveys, the percentage of dentists reporting embezzlement increased by more than a third (i.e., 13% of those surveyed). This growth is a significant and alarming trend.

West Virginia Woman Pleads Guilty to Bank Fraud of $120k

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Melissa Evans

According to the information provided by the United States Department of Justice, the events happened between the years of 2011 and 2018.

In her position, Evans was responsible for accepting payments, posting entries into the accounting system, prepared and conducted deposits on behalf of the office and was in charge of their accounts payable, the information said.

During that time frame, Evans knowingly forged the signature of her employer without authorization and misappropriated checks from several institutions including the Boards of Education from Wood, Jackson and Pleasants counties.

Her employer’s forged signature made it possible to deposit the checks into her personal account with Poca Valley Bank in Spencer, the information said.

Throughout her scheme, Evans fraudulently appropriated more than 300 checks and embezzled more than $120,000, Stuart said.

Evans also forged her boss’ signature on three checks drawn on patients’ personal bank accounts, the information said.

After the checks were deposited into her personal account, Evans used her debit card or wrote checks to access the funds, the information said.

Evans owes the $120,000 in restitution, the information said.

Sentencing is scheduled on Nov. 18. She faces up to 30 years in prison.

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Content retrieved from: https://www.newsandsentinel.com/news/local-news/2020/07/palestine-woman-pleads-guilty-to-bank-fraud/

prosperident Webinar Series Sept 16, 2020 You Ask ; We Answer

If you want to check out other webinars that we have done, they are all available here – https://www.prosperident.com/prosperident-webinar-series/. Or if you prefer to receive content in podcast format, Prosperident’s The Dental Practice Owner’s Podcast is now available on Spotify, TuneIn and iHeart Radio. You can subscribe using one of the buttons below.

Prosperident Pulse #98 September 2020

Want to receive our newsletter automatically each month?

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September 2020
Next Webinar Sept 16!
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This month, we have a special treat for you. We have invited our audience members to submit questions, and if we use yours on-air, you win a prize.
David, Wendy, and Amber will answer your questions on Wednesday, September 16, at 8:00 pm Eastern / 5:00 pm Pacific.
To register, click HERE.
Do you have a question you want us to answer? Click HERE to submit it.
If you want to catch up on our previous webinars (we had some great topics like Forensic Hiring and
Steal and Conceal; What Serial Embezzlers Can Teach Us), you can access them at THIS LINK.
PACE CE credit is available.
We look forward to having you back in our audience!
Dental Podcast
Hear dental industry leader Interview David Harris in a wide-ranging and thought-provoking discussion.
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Click HERE to play the episode.
Did you miss a previous newsletter? We archive them HERE.
Profiles of the Embezzler – the Narcissistic Sociopath, the Hero and the Sugar Momma
These are some of the common profiles of embezzlers.
Many thieves display sociopathic characteristics, and also markers of a narcissist. Psychological literature recognizes this combination as a narcissistic sociopath. The accepted traits of an antisocial personality disorder (sociopathy) include:
  1. Superficial charm and intelligence.
  2. Unreliability.
  3. Untruthfulness.
  4. Lack of remorse.
  5. Inadequately motivated antisocial behavior.
  6. Delusions of invincibility.
  7. Failure to learn by experience.
  8. Failure to follow any life plan.
Something to Talk About…
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It’s a bittersweet moment in my life as I pack my son off this week to begin his next chapter. He is off to college 1,200 miles away to study math and computer science, and play basketball.
I can barely remember what it was like not to have Ethan around. From the impish, perpetually giggling four-year-old who endlessly made me chase him around the house to the gigantic teenager, chronically leaving his size 16 sneakers where everyone would trip on them, he has always been there.
I feel badly for his generation. The COVID restrictions have meant that some of the important life events, like high school graduation and a prom, have been skipped over or radically altered. The college experience is going to be quite different from the carefree one with which we were blessed.
We adults have sufficient perspective to recognize that eventually, the disruption will pass, but I am not sure that teenagers can contextualize as easily.
In the way that the parents of baby boomers were forever altered by their experience coming of age in WW2, this group will always be the “COVID Generation”.
Ethan is handling it well and is excited about upcoming challenges. I hope that, if someone in your family is entering a new phase, that it goes equally well for them.
Sincerely,
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David Harris
We are Prosperident, Dentistry’s Embezzlement Experts
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