Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard: It is just a huge honor for me today to be podcast interviewing Bill Hiltz, he's the founder and CEO of Hiltz and Associates for more than 20 years bill has been helping dentists settle their most pressing and complex problems Bill's qualifications in engineering biology computer science data analytics education and business help him to provide thoughtful insight that is generally unavailable elsewhere. Since 2004 bill has been primarily focused on matters involving fraud embezzlement and litigation support for dentists and practice owners services include and not limited to continuous data auditing and assurance exploratory and diagnostic embezzlement examinations forensic investigations, fraud prevention and detection and litigation support in forensics. Are you a dentist or practice owner in this predicament do you trust those who handle your money to be honest but lately your intuition is telling you otherwise or perhaps you have cause to believe that you're being embezzled and you need certainty and direction Bill can help whether you are a large group or a small family practice let us put our unparalleled talent extraordinary skill set and uncommon experience to work to resolve your problems. So my first question is is this something that happens once in a blue moon Bill or is this more common than dentists think?

Bill: Well I'll go back to when I had my very first I've been involved in dentistry for over 20 years and the gut involved on the practice management side I was selling software I practice management software and got involved in dental informatics did some work for the military involving all their hospitals and dental dental records electronic dental records and so on and my wife who's a dental hygienist was working in a practice and she came home one day with her spidey sense tingling and said I think there's something going on and so I knew the doctor and gave him a call anyway long story short $68,000 later we had the answer his office manager was stealing. She was charged her name was Sonia Green she was subsequently charged and and convicted I don't think she went to jail and it was interesting because Halifax as you had said is a pretty small City I mean we probably only got about 350,000 people so ah there's about 200 150 general dentists maybe another 50 or 80 specialists in a city that size I thought that was pretty interesting well you know how word of mouth is within the dental profession and then within a few weeks or perhaps a month later I get a call from somebody else hey Bill I heard you could do this and that's what that's what really started it prior to that I was doing things like you know buy sell transactions helping doctors with the computers you know doing help me with their lease negotiations they want to build a practice looking for sites and so on. So within a year but a year and a half I had done six of these in our small little city and then it just took off I never knew that there was a magnitude of this in dentistry and but it's not unlike other businesses as well I think physicians have a very high rate churches not-for-profits anywhere where the person who's making the money or supplying the money doesn't have direct contact with their business and they have to delegate a lot and put a lot of trust in people around them do to do the right thing.

Howard: So is intuition a is that good I mean do you think if you're set if a hundred people called you up and say bill right I got this feeling and how many times are they wrong?

Bill: I can't tell you about the wrong ones because they turn people away I do get people who come and they I mean I don't chase ambulances so people will call I'll go through their situation in many cases I'll tell them what to go look for they have a specific complaint you know they've seen something on a day and sheet they've observed something in their practice and it's causing them it's predicated them to pick up the phone and call or send me an email and you know I would say about half of the time I'll tell them what they need to do to address that specific concern and they go away and they do that and they say great thank you. So I think those are sort of false positives or false alarms I mean if you don't understand how embezzlement works if you're and a lot of dentists they look at numbers the same way that accountants look at teeth and they don't understand the surfaces and the angles and the lines the dentists don't understand the numbers and they so they can tend to overreact. Of those that do engage my services I would say probably about half of them are right when they come and one of the things that I will do Howard is if I'm not a fan of doing a large-scale investigation for someone who comes in and needs some specific concerns will be like going into the emergency department you finger need stitches and they've got you off to the MRI and they're doing a gastric bypass doing all kinds of gastric things to you and all those sorts of stuff because it's not necessary so you know if someone does contact me and they have concerns it's always to take baby steps towards answering the question whether or not they have an employee that's dishonest and primarily that's what most of the doctors call me for but I do get a significant amount of cases involving civil litigation where we have one practice owner suing another practice owner one dentist suing another dentist or buyers or more situation that seems to be quite a few of those where you know young doctors are just and you and I know your podcast is geared towards this so I'm gonna speak to it now, if you're a young doctor and you're looking to buy a practice particularly in this market today where there's so many DSOs and the corporates are buying this stuff up make sure that you have somebody on your side that has understands the required diligence that needs to be done and make sure that the attorney that you have that draws up that agreement that contract of purchase and sale or the buy sell contract between you and the dentist has all of the required remedies for when things go bad because when they go bad if it's not in writing that's how things end up in court. Howard you've been in dentistry long enough you've seen this kind of stuff I'm sure you have you know and it's unfortunate so with the buyer remorse situation is when the dentist buys the practice and six months later he says I bought a lemon and the reason is well what is the reason you know and sometimes there's there's there's litigation over that and I get involved in doing so the interpretation and other numbers and calculations and things like that.

Howard: For me I just love the way you opened up with dentists look at numbers the same way accountants look at teeth.

Bill: Yeah exactly

Howard: That's so profound, so let's start with them I dentists don't know their numbers I've been a dentist for 32 years there I could find no one in Phoenix today that knew they're 2018 return on equity return on assets I mean you go to any dentist's office and a hygienist walks out dismisses the patient I'll say hey she just did a cleaning exam bitewings how much did that bill for they don't even know I'll say well you even know what a clean cause yeah it's like then they have they sign it for 10 different PPOs they have no idea I say well you know she's been working for you for nine years do you think every time she does that you make a dollar I mean they just I love it dentist look at numbers the same way accountants look at teeth, they truly don't care. Let's start from the basics because my my homies a quarter still are in dental school the rest are under 30 they're probably associate somewhere they want to do it right so when they're gonna go set up their own they're gonna they're gonna come out of school they're gonna believe that if they go work for Heartland they'll live happily ever after and sing Kumbaya and then after they quit and quit and after after they had five different jobs in four years and they're ready to just like burn their house down and quit they finally they finally dive in the swimming pool headfirst and say I'm gonna do my own so first questions are basics is any practice management software better than the others to prevent this type of stuff?

Bill: No I not in my experience I mean practice management software varies widely if you ask me that question ten years ago Howard I would say yes but most of the stuff like you look at Dentrix and Eaglesoft and so you know the other ones that are out there Open Dental they've been around for years they've been around for decades so you know they're mature products and the problem is and it's not really the practice management software that causes is the embezzlement is just a tool that's used often times by frontline workers who are collecting payments from insurance as a way to conceal with that so it's what I'm gonna say is no practice management software is better than the others in preventing embezzlement but the application if you follow the recommended manufacturer's guidelines with having the proper security having different access levels for people to do things running the proper reports closing out the months following all the recommended checklists that the manufacturer Dentrix has the Eagle Soft has and they all have these checklists if you do that and you're gonna reduce the chances that errors are gonna occur and that you're gonna be making a mess of things is it gonna is it gonna make it easier for you to diagnose embezzlement if it happens I don't think so I mean you know bluntly when people steal they'll go to whatever extent is required to conceal it and if you do if you see might say 30 patients a day coming through your practice and you're open four days a week 120 patients and I decide that I'm gonna steal from one patient out of those 120 good luck good luck and the reason is you know if I and again you know I'm your employee it's not it's not that you pay attention to everything it's that I pay attention to the things that you don't pay attention to as an employee you know it's theft by exception you've heard of management-by-exception you look for things that go outside normal variances if you're stealing you're very sensitive to being caught that's the first question that everybody asks themselves will I get caught and if they find a place where they can where they can do that dishonesty and not get caught then they will.

Howard: What did you call it on it's by deception you said manage it by exception?

Bill: Deception by exception

Howard: Deception by exception

Bill: Yeah you know dentists will always say you know what should I be looking at and I said you should be asking yourself what don't you look at because that's what if someone is stealing that's what they're focused on they're focused on the things that you don't look at if you're the type of guy who is coming in or gals coming in every month and looking at that AR and I know some doctors get fixated on it they're 30-60-90 and they want to keep it down if that's the report that you're focused on then I'm gonna turn my attention elsewhere but besides this part from talking about the numbers I think what really the message that I want to bring to dentists Howard is that you know you need to trust your instincts you need to delegate to individuals but you always need to maintain a healthy dose of skepticism look and everybody no matter if you're fresh out of dental school I can walk up to anybody who's graduated dental school and say hey which one of your college buddies are which one of your highschool buddies would you not lend money to and they're gonna pop out a name right you know people like that you guys I'm not gonna lend that person ten bucks I'm never gonna get it back, how do you know that why do you know that you know that information because something happened along the way and you've observed so that's the type of skepticism you need to have when you open up your practice when you go in but your employees are not your friends if you think that they're your friends and if you think over time that they've been there and they're there to take a bullet for you and that they're they're gonna be loyal and trustworthy and honest stop paying them and then you'll see how long that friendship lasts you know they're not your relatives they're not your wife they're not your mother they're employees. So always have that segregation that doesn't mean that you can't be I was the word I'm looking for, I mean it doesn't mean that you can't be cordial that's that's appropriate word, you can be cordial with your employees but they're certainly not your friends you know and I think a lot of dentists that have that have prone to have problems in their practice don't draw that distinction and they tend to establish that trust relationship as you would have with someone who's in your family or in your close circle of friends and then when something happens in that person's life then they can take advantage of you.

Howard: So I am you know of all my friends they got embezzled over the years and all the people on dentaltown I mean I mean dentists are rich I mean they you know they're yeah they make a lot of money it never really was the money it was a lot of my what stands out the most is it was the trusted her it was her child's godmother they cave I mean they're just crawled they just I mean the money is not the issue I mean I've seen dentists cry about this they just could not believe their betrayal so it's this is a very emotional subject isn't it?

Bill: It is and I find that a lot of people some people will open up many particularly and I'm trying stereotype here a lot of the guys I talk to will defer they'll have a flat type of effect when they when they talk about this so when you start saying you know how concerned are you well I'm not that concerned even when you present the embezzlement they it's okay what are the checklist and the things that I have to do but inside inside if you could look through that Joe Harry window and and see that what's going on inside that person you're right there's a lot of heartache there's a lot of stomach lining being lost particularly when you know that person was trusted like you said they babysat their kids they went to their cottages they went on trips together yeah it is it can be a very emotional subject. Talking about dentist being rich you know in order to steal they have this thing called Creasy Donald, Creasy came up with coining the concept of the fraud triangle and you had to have motivation opportunity and rationalization and there's modifications on that but as a behavioral theory it has to it has stood the test of time so the first thing is you know you have to be motivated to steal and you know bluntly people can be easily motivated to steal under certain situations all of us can be motivated to steal under specific conditions regardless of who we are we will steal if we have to if it and I'm gonna give you those types of situations but you know so the motivation you have no control over that the employee works at home they could go through a divorce they could they could have a son who's home I mean I've seen it all they have shopping disorders they they want to spend money on vacations they got kids they want to send to college or they have medical bills or they have a gambling is a big one gambling problem these people are typically women and there was a researcher her name is Dr. Linda Grounds and she's done some interesting work with female embezzlers and one of the conject one she's came up to is that a lot of the subjects that she's interviewed of our female embezzlers not only in dentistry but in other businesses they stole for what would be what would be called higher loyalties so they steal to maintain or keep a relationship or they steal to look after a loved one a medical bills or a son who's a drug addict or to keep someone out of jail to pay legal bills you know as opposed to man who'll typically steal for themselves and use the money for themselves. So yeah it's I mean it's it's devastating but going back to the thing about the crises triangle now when you look at motivation which is the other leg of that triangle are not motivation rationalization it's not hard to rationalize stealing from a dentist if you go on some of the public comments on some of the forums not on dentaltown but on the news articles so you know go to the San Diego Times where somebody's got embezzled a dentist and look at what the public comments are and these you know the public's yeah darn tootin right stupid rich dentist lost all his money you know and these this is this is the public sentiment so nobody has any sympathy for the did for the rich dentist who wasn't smart enough to look after their money and someone stole it so it's embarrassing it's embarrassing for doctors and it's easy for staff to rationalize stealing so that leaves us with opportunity and that's really the only place that the dentist has any real control over what happens in the practice, remove the opportunity and remember earlier I said to you every the question that everybody asked before this deal is will I get caught doesn't matter if you have a five year old kid and you're trying to steal some gummy bears if from your brother the question you ask is will I get caught and if you answer the question yes you won't do it so that's the perception of detection the reason you don't speed on the highway you don't see any cops around but the reason you generally don't speed is because you think someone's gonna be around the corner with a radar detector and they're gonna catch you and that's the environment that you really need to create your practice it takes time and it takes discipline and it's not difficult it's moderately difficult to do it's called the perception of detection. I'll give you a real good example of a good friend of mine Dr. Paul Downing, Paul was a master of this you know his staff thought you know he always reviewed he would not leave the practice until day and was completed he wasn't the kind of guy said here you do the bank deposit I'm God kids got soccer you know I want the bank deposit done on my desk he hit the team every day and every day he asked for reports and those reports were given to him and he took them home and he achieved them you know and then he would come back from time to time and take those archived reports that he took home and take them back to the office and do a random comparison people were aware of this and they knew it I don't think he ever had a problem but his staff loved him and he treated everybody fairly and he and and you know so you know the perception of detection is the biggest thing that that dentists fail to instill and inculcate into their practice with their staff and you know it begins you've heard the the topics you know tone at the top you have to be a leader and every practice management consultant out there is trying to say doctors need to be leaders you know and you do and it's a difficult job when you're chair side and your interests are really clinical you know so it is a problem you know.

Howard: So that the fraud triangle that's an interesting deal you're talking about you're talking about Donald R Creasy well-known criminal just developed the fraud wrangles opportunity rationalization pressure motivations opportunity what are your internal controls okay my homies have none employees not enforced they're not monitored they don't record their phone calls they don't even have cameras on their deal no separation of duties you know so the canceled checks go to my house one receptionist can go get the mail and make the deposit another one I mean it gets the mail enters the checks another one makes a deposit you you you the way I've got it figured out in my office right now I think to embezzle for me I think dawn Laurie Stacy at a minimum after I think four people have to be in on it and I figure if all four of them are in on it shit I want in on it I mean I don't want to miss that party.

Bill: It it's the likelihood each time it's the rule what is it the law of probability if you flip if you flip a coin once you got a 50-50 chance of getting heads now you flip a coin twice to get heads twice in a row it multiplies 50% times 50% so now it's a quarter of a percent. So to have one person steal is more common than having two people steal because they have two people steal you need to collude so the probability that they have that event happening and I'll get doctors will call me see I think two people are stealing from me the probability of that happening is very low not that it doesn't happen because it has and there's been documented instances of that and I've had cases like that but the likelihood of it happening is low now in your case if you needed for employees to collude I think the probability of that almost reaches zero if that was a requirement for people to steal that you needed four of them to be aware of it that's a very powerful self control regulation that you've got built into your practice.

Howard: I said my years of seeing this the people that were upset the most that caused the most grief and all that kind of stuff I'm the worst one ever it was his wife she couldn't decide whether to divorce him not so she was sending about six thousand dollars a month to Australia and then about six years later when he finally figured it out she said you know what I do want to divorce you and left man that's tough.

Bill: Yeah I've had I've seen cases like that you know where spouses will be stealing from another spouse husband stealing from wife wife stealing from the husband they could both be doctors one could be a lawyer they could both be professionals one could be stay-at-home it doesn't matter but ultimately when you go back to it all there's a reason the people are motivated she was motivated in the run-up to a divorce and maybe she was saying to herself if I don't squirrel this stuff away in her mind I don't squirrel this away I'm getting squat so she motive she was motivated and she rationalized it you know and that's unfortunate. That's the dark side I mean I get I do see those types of things you know that involve affairs you know employees that are doing you know illegal things other than just involved in theft you know the disputes among dentists when two dentists are suing each other are involved in charges those are fairly sad you know.

Howard:  What was the last thing you said?

Bill: When two dentists are suing each other you know or a group two companies two dental companies or multiple companies or suing other multiple companies but there's still people behind this you know and it's usually in a situation where I bought a practice from you and I'm unhappy or I've sold my practice to you and now I want it back and I'm still working there as an associate you know there's all these different these are commercial litigation situations but there's a lot of heartache behind them and there's a lot at stake. Let me give you one example and this is a pretty interesting one I've seen this one twice Howard and I'll go back to the most recent one so the doc had the practice practice was you know average type practice is probably about 1.2 million had three hygienists sold the practice for about at par this is in California for about 1.2 million now my client who bought the practice was already a seasoned producer he could produce seventy five thousand on his own in a month no hygiene just on his own so he was at a school probably five six years but he knew what he was doing in speed was up so he buys the practice practices 1.2 he buys the practice and six months later he's saying I'm not I'm getting ready from here well what's changed the patient was the same the staff are all the same I haven't even painted a wall the hygienists are all the same I've changed nothing and changed no schedules I'll wait a little bit longer he waited to nine-month mark and then he called me here's what happening what was happening was when the seller had a practice the sellers spouse worked in the practice as the office manager the three hygienists that were in the practice they go in they do their srp polish bitewings you know the standard 50 minute or 45 minute drill bring the front desk or the insurance payment and would be put through now because if you have insurance coverage preventive work like hide services are usually covered at full or bothal so she would his wife would submit charges to the insurance companies for work that was done so instead of the unit of scale there'd be two units here now just follow me through with this so this is the doctor and his wife that were doing this okay my client buys the practice and now when the hygienists come to the front desk and hand in one unit of scale one unit of scale gets billed so now hygiene revenue Falls it falls by three hygienists by the difference of what was being over billed so the revenue of the practice was overstated by about two hundred and fifty thousand dollars a year because of this hygiene thing that was going on right so how do you prove that right it becomes difficult because now you've got to go back to the vendor and not withstanding the complications of saying the other the seller was committing healthcare fraud because they were, not withstanding that how do you go back and make a case in a civil claim where you're saying I just bought a practice and I'm not making the same revenue as the guy who sold a practice to me because most civil litigators most civil litigation attorneys are gonna come in and poke holes in that they're gonna say well you're not the same dentist you don't do the same treatment you know the hygienist don't do the same is too many variables you know you're not making as much money because you're not as good as the guy who sold the practice to you right. So the way to do it in the way that I did it was to do it on time based and of course hygiene is time based so to go back through and do an analysis of all the different time based procedures that were done and come back and basically say what's it's called a zero day it's called a and the Medicaid people do this right if they're looking for folks who are getting called to the rug by Medicaid all right they'll do a time based analysis and basically they say wait a second now you just submitted X number of procedures and your office is open these many hours and these don't fit you can't do this much work in this little time and that's the same approach that we used here it was a zero day approach ultimately you know it was settled my client got got some money back on his purchase and the matter you know and my work was done but those are the kinds of things where people get involved in a remorse situation they buy something they don't do their diligence going back to the to the young people who are gonna go and start buying these practices you know particularly in an urban setting look if you're if you're buying the practice in your hometown you came from a hometown of 5,000 people in Idaho and you're gonna buy the practice of the dentist that you went to as a kid I don't think you got too much concern you know a small town but in urban centers practices change hands they change for large amounts of money I really think you know you need to you need to have a really good team on your side and people who are gonna ask the right questions.

Howard: So let me do what I do and talk about the the dark side inappropriate reality dentistry uncensored so many of these cases they're a the reason they take these risks to embezzles because she's thinking okay I'm having an affair with you and you're married with three kids and if your wife found a got a divorce you'd lose a million so if I'm stealing five thousand dollars a month what do you care or they're splitting vicodin or they're ordering it from I mean dentists can order vicodin from you know pharmaceuticals and so a lot of times it's they they're they're doing something inappropriate with sex drugs alcohol with one of their team members and it's all good and fun until it's not and then it's really bad and ugly do you see that?

Bill: It is I do see it yeah I do see it and in a lot of cases what dentists really want to do at that point in time is to be able to cut their losses it's not so much that this person was stealing from me you know it they're not concerned that the person was stealing from them they're probably not as concerned that during that person's employment one other prescription pads went missing but what they are concerned about is public disclosure and containment and embarrassment and financial ruin and professional ruin and you know in those cases you have to have a good team on your side you know I mean look everybody's got to be accountable for their consequences and I mean part of what you had talked about today was what was happening in politics and you know everyone everyone gets challenged for the choices that they make and I think that you know if dentists go off side you know they're doing they're doing things they shouldn't be doing that caused them to be in a situation where they can lose their professional license if these things were exposed in the public forum if they're if their motivation is to do the right thing and and try and contain it and sequester it and keep it to the minimum impact on themselves then yeah I mean I've helped people do that with with their attorneys and go through that mess you know but I've also had again you know if if the doctor is involved in any type of extramarital relationship with a staff member and that staff members stealing most times you'll never hear of it they'll just let that person go they may even give them a payout and that's it is done and forgotten about and on to the next they're not the type of people who call me often.

Howard: Yeah dentists to me got me come on okay look in the mirror and then look at this girl who really wants you I mean she's really hot and you're really not I mean yeah I mean everybody else can figure it out from a mile away and then and then this guy can't believe it it's like really you can't believe it or they're no working mirrors in your house I mean how did you not how I mean what how else would you explain this and so humans they to rationalize anything they want to believe and much like I gotta get out of here early tonight because Britney Spears is waiting for me by my car and I you know I can't keep her waiting so they just they just believe a whole bunch of irrational sets. So we first talked about to prevent this you know don't sleep with your staff don't do illegal things of them but by the way when they fear when they fear publicity like they always settle because either they don't want this to get out I don't know anymore I see so many movie stars and so many people that just fall down on their back land on their head.

Bill: Yeah the celebrities can do that I mean they can change their gender they can they can they can go to rehab seven times in a Norfolk in often cases it's going to elevate their career your your your regulated you know your professions regulated if you would start doing things like that particularly anything of a criminal nature you know the board is going to discipline and I think it's the regulatory compliance so for example you know take the example of the doctor who fired someone who was embezzling but that person was also had their hand in to the end of the portray in to the prescription jar you know pads went missing or you know the doctor was aware that this person was phoning in prescriptions for perks or vicodin or whatever you know and turns up and becomes willfully blind and that term willfully blind will cause you to lose your license if you're up in front of a board because they're gonna say what your mother said you shoulda known better and you shouldn't have done it right and there's no excuse. So you're right that's it's not the negative publicity it has its board discipline

Howard: Yeah I didnt think of that and the board can be brutal. Okay when you list the things that you're talking about you know fraud and doesn't litigation as a board my homies get that they don't know what continuous data auditing and assurances?

Bill: Well that's something that's gonna have to be taken off my website because that's something that I don't do anymore and and did involve doing regular monitoring coming back in and doing a monthly visit and going in and looking at different things that are happening in the practice but no idea if first of all I didn't find it to be as effective as just going in and doing what I would call a random audit companies always do internal audits any company should do an internal audit and you know the thing about dentists is the they don't they don't know how to do it their CPAs don't know how to do it CPAs know how to do internal audits but they most of them don't know how to go in and audit dental software because they don't understand insurances and that's the easiest place to bury something like you had said you know oh my god is a scaling 68 bucks or 90 bucks is this PPO covered at 50% do I write it off do I collect the co-payment how do I know cash wasn't collected and it was written off you see a lot of that stuff.

Howard: So I want to make a couple other points the kids out there because my whole mission is I would go out there and find every dentist has served dentistry 30 years and then transfer all those lessons to the kids are just getting out.

Bill: Absolutely

Howard: and you know this goes back to humans are an incredibly complex entity I mean they can rationalize anything I mean I was in Wichita Kansas that when they busted that serial killer for 20 years he you know where you work you know where you work so in the church anyway but anyway so humans can be crazy they can rationalize anything they do lots of crazy stuff but here's another reason I don't want you taking government insurance to do in Medicaid or Medicare because when you're wilfully neglectful I mean you're not watching a deposit you're getting embezzled from because you're intellectually lazy you're not separating the task you're not you're not working it's five o'clock you just want to go home and watch the gosh-darn sacred Seattle just kill the the 49 I get it I totally get it right but when you start making those mistakes billing Medicaid well they're not going to say no Karen messed up a hundred times know you're going to jail and they're gonna lock you when you when you get in bed with someone who has a gun that can kill you no one's telling you to get in that bed I I don't want to get in a relationship to where if I just end up being stupid howie and do something stupid i end up dead and i look at these medicaid advantage deals and you got some Attorney General that no one knows his name and he wants to be on the six o'clock news and then the people I know and I mean I know one case in particular his wife was the most amazing woman but she was she was you know she had her limits and whatever but anyway long story short when they finally all figured out all the mistakes she made they had to move to Mexico because if they stayed in Missouri they would go to jail for a decade in sight really so we have to leave our country because you know shit happens when you when you mess up with Delta in your stand yeah you guys are gonna have a pissing match and no refund money and whatever whatever whatever yeah once that goes in the mail and crosses the state line now it's a federal offense and you start bringing in the feds and the feds the only thing the feds want to do is is get their picture on the six o'clock news that they just threw fat Baldy dentit in jail for 400 years and and I get it if the guy was doing something intentionally evil but a lot of times it's just stupid mistakes.

Bill: Yeah but it's not only that you'll see that governs against the government if you steal against any government agency chances of you being convicted as a felon and doing a much harsher penalty as higher and the reason for that is the number of victims when you steal from Medicaid you steal from the taxpayers and there's a lot of victims and the government is entrusted to manage our money so you know I've seen cases where someone will steal $20,000 they'll go to court you know they'll get a house arrest and do a little bit of community service and probably have to go to gambling rehab you steal $20,000 from the government right and you end up going to prison or you end up having harsh penalties you you know. So I understand the Medicaid it's not just that they come down hard on Medicaid they come down on they'll come down on anything to try tax fraud and see what happens you know steal steal money that way.

Howard: Yeah and so funny to steal money when the United States government and the Federal Reserve prints more money I mean God and Lehman's day sure it took him three years to come out to say that they printed eight trillion dollars cash so for the government to convince you of Medicaid fraud that is that is probably the funniest jokes of all time.

Bill: Well yeah it is and but the thing is you know you're right if you but if you sign on to Delta or met or Aetna and you're on any one of those plans and you find out that your office man and I had a case I had a few cases like this and in fact you know if you if you sign on with an insurance company and you and your office over bills so you've got you know the person was working at the front desk who wants to be the rock star and doesn't want to collect money from patients in other words I don't want to collect $50 patients are always complaining about money they're complaining about co-payments so hey you know instead of saying you know your co-payment today or this is gonna cost you 200 bucks oh maybe I'll make that MO and MODL and submit at the Delta and I'm gonna get the extra money and they actually take those overpayments and deposit them into the doctors account so I've had what I'll call you know matriarch of the practice over bill insurance companies and they don't receive the benefit they don't receive any money the money goes to the patients in the form of dental services that they would otherwise have to pay for. Now in situations like that when Delta comes knocking on your door what happens do you go to jail no Delta says here here's a spreadsheet you owe us money and they want their money and if you pay Delta back they'll take the money they'll probably flag you as a provider or remove you from a PPO or if you blame it on your staff they'll let you back in and they'll monitor you not so with Medicaid right not so with Medicaid. So if you have an employee who has that same mentality I want to do well I want and the reason there interestingly enough in the cases where there was over billing and insurance it's often because people want to for the ones that don't benefit directly they want to be liked by patients of the practice so hey if I don't charge you $100 co-payment and I'm gonna do something with your insurance to make it work I'll see what your insurance covers and they come back say don't worry you don't have to pay anything today patients love that doctors also love it because extra money's going into their bank if you have a person working for you that has that same type of self in that self entitlement but in type the a entitlement to feel that they have the right to do that with your dental license they'll do it with Medicaid and then you know you're gonna end up like Roy Shelburne or somebody else you ended up going to prison right.

Howard: So you said his name so what do you think of his story did you believe that story does it doesn't add up, what are your thoughts?

Bill: You know I'm gonna you know I I don't know I mean is it's a story I wasn't there I didn't read the court transcript I've read other people's narratives of it I haven't met Roper I  haven't met him to your historian person so I gotta say I don't know I don't know.

Howard: Are there any red flags to the story I mean is it possible that maybe he was more liable than he talks about?

Bill: Well in a case of a dentist in third largest city in North America and I'll let you figure out which one that is anyway he contacted me it's it's Toronto Canada it's New York LA and Toronto's number 3 anyway this guy was there and he had a woman working for him for her she must have been there for 20 years and what she was doing was not collecting co-payments now Canada is almost a new line for PPO as you started to bring those two plans in the into the Canadian dental field but Canadian organized dentist has been virtually lobbying against it but the insurance companies are gonna win anyway and and they've started to do that but my point is is that you know instead of collecting that twenty five dollar co-payment or that 100 dollar co-payment from the patient the person would just write the balance off now so if you do the math if you say if the insurance company says I'm going to pay 80% of a fee and the fee is $100 an insurance company pays 80 and the patient is supposed to pay 20 $20 right but now if you build the insurance company a hundred and they pay eighty and then you just forgive the other $20 the insurance company saying we've overpaid because you intended to only pay charge $80 therefore we'd pay you $64 and you collect 16 from the patient right so there's an overpayment they expect you as part of that plan to collect from the patient well this went on for years I'll bet you went on for about 10 years where this person was not collecting co-payments so the guy calls me and says you know I'm scared I just found it that she's doing this I think well you know what's gonna happen to the insurance company's gonna is my license gonna go out the door what's gonna happen and so I said well so what do you want to do and he said well I want to make everything right I want to set it right I and I want to I said okay well I'll help you do that but I gotta caution you that this could be a very expensive endeavor if she's been over billing insurance companies and I did a quick calculation of as you know to take you know if you're heavy if you say if you had 70% insurance and I did the math anyway and I came up with a number of about $300,000 and I said you know what you probably over the last 10 years haven't collected $300,000 in co-payments so take the percentage of that and you'd have to pay it back, he said well that's a lot of money that's okay so well how do we go about this so we went and we contacted a few insurance companies and started to go down through that process on his behalf and you know found out what the differences were in recent years and made some settlement offers and we started to work our way down through the insurance companies and after he had paid back about probably fifty or eighty thousand dollars he said you know this is really starting this is really starting to be a lot of work you know I'm doing this work I'm going to the insurance companies and I'm saying hey I need you to audit me and I'm gonna do all this work and I'm gonna give you back a pile of money so I think he decided to go back we talked we talked with his lawyer and we went we went back for three years even though we knew and went back further but my point is you know in this case here you know he wasn't contacted by any organization he wasn't pulled to the carpet by any insurance company he went there volunteer early because he was afraid that you know if this came out that he may be sanctioned or disciplined or have some type of legal action against them they view this is this is the point that I want to stress about Howard is that at the time in Canada and there are plans like it in the United States where it's non PPO in other words you'll accept the insurance but you're not on any binding contract with the insurance company so if you don't have a contract with the insurance company and insurance fraud or misrepresentation gets treated a little bit differently so if you're on a PPO one of the clauses and almost every standard agreement is that you know if you find out that there's something wrong and your billing statement that you're to notify the insurance company immediately you know and they'll take that to heart if your staff members been over billing or if you've been over billing or something's been happening in your practice and you don't bring it to the insurance company's attention they're gonna hold you liable liable are willfully blind you know in terms of numbers just to talk about numbers for a minute you know you'll see things that are out there and people say you know 60% of dentists are gonna get stolen from and then they'll put it all these big apocalyptic cases and I've done cases half-million-dollar $680,000 you know cases where people have lost tremendous amounts of money but for the average dentist you know the loss is probably between twenty and fifty thousand dollars and the reason is that the fraud schemes you know are don't perpetrate for decades oftentimes dentists do follow their intuition particularly more the younger dentists who are more computer savvy and they you know they understand a lot of the things you know they'll look at things know ask questions a little bit sooner so you know when I see this these statistics out there that they say you know there's a 60% chance that you're gonna be stolen from as a dentist and you're gonna lose you know hundreds of thousands of dollars or you know I mean you know I'm not seeing that in my line of work you know I don't.

Howard: The one thing I'm seeing is that from 87 to today mm-hmm I think there's at least five new ways to embezzle today than in 87 when you are on a pegboard system and you had to lick a stamp on each letter.

Bill: Yes that there are there are and you know and people will talk about that as well but so if we talk about the occurrence and frequency of embezzlement in dentistry I'm gonna say that yes almost you know sixty percent of doctors will incur some type of financial loss as a result of an employee who willfully creates that loss I'm not talking about I just you know I just broke a bottle of Botox on the floor or you know I just ran over your something with the cart you know breakage and things like that no I'm talking about people taking money and willfully doing it letting their sister-in-law leave without paying or doing something like that you know there's the acute instances and then there's the chronic ones you know and I think a lot of dentists will suffer acute embezzlement this is where someone will go in and do something a few times and and it's for small amounts of money usually waiving copayments or taking supplies home or doing something but it still causes the employer loss or padding payroll that's a huge one you know adding an extra hour or two on their payroll and getting overpaid for work that they didn't do it's still theft you know if you include that yes I'm gonna say the sixty percent. What my gut tells me is right now at any given time for every I'm gonna say fifty dental practices but I think the number might be even lower maybe forty one in fifty dental practices is being embezzled and that embezzlement is at a chronic level which means it is being repeated and it is ongoing and it will not stop until the person leaves the practice the dentist sells the practice or the practice or it is uncovered those are gonna be the three events that are gonna bring that out and when people steal they generally will steal less than five percent of revenue and you talked about dentists being affluent yes they have they have solid income statements you know they're they're high wage earners which means you know if you steal five percent of most blue-collar or you know not to generalize here but if you steal five percent of the average income the average American income they're gonna feel it they're gonna say hey you know I gotta reduce my cell phone bill or I can't save up for a vacation or I can't put money away in savings but if you steal five percent from a dentist the dentist's lifestyle doesn't they still have trips they still get spring break they still trade their cars in every four years they still buy new equipment but what is taken away from that is the amount of money that they would normally put into a retirement so unless someone is stealing at a level that affects your ability to live and pay bills it doesn't become that noticed so most will steal less than 5% of revenue probably in the range 2 to 3 to 4 percent maybe you want to affect factored that out if you're a million dollar a year practice 30 to $50,000 and would fly under the radar and these are the types of frauds that will go on for many years so I'm stealing if you're collecting a hundred thousand a month I'm stealing two to five thousand of that and that can go undetected for long periods of time and those are the ones where you see you know poor you know Dr. Smith five hundred thousand dollars this woman worked for him for 20 years and for stealing for 10 of them you know that's how you see those. The other ones where you see those large amounts of money or where people are put in who do these acute but very intense frauds that don't last long they're nine months and they bankrupt the company or they bankrupt the practice because they've been given the authority they've got access to the credit cards they got access to the bank accounts they can do financial transactions they can move money around they're usually an office manager position and those are limited by the fact that they they basically kill the host so if you think of dishonesty as a parasite you can get the symbiotic relationship where it just weakens the host and those are the ones that are long-term chronic those are the ones that happen when when the person working for you is your best friend the person was working for you looked after your kids the person was working for you you know is there first thing in the morning and their last day in the evening those are the long and chronic symbiotic type parasitic relationships the other ones are the type of parasite say they just killed a host and you've seen those as well I mean it was a way in the news recently there was another I think was an orthopedic no was an OBGYN and I didn't mean the laugh when I said that but and the the yeah this is female OBGYN over half a million seven I get the amount of money but the doctor said I had to sell the practice I had to bankrupt I think the bankrupt the practice you know so this is someone who came in and just a bull in a china shop you know and so the hurt the hard part for a lot of doctors is and I and you know they work very closely with individuals in their practice these people have worked with them for years they finally think everything's working patients are happy money seems to be collected there's a few little glitches but stuff gets done some insurance lags you know maybe one day a week you come out and the waiting room was not empty most days things seemed to run smoothly and those are the ones where complacency sets in and then when the opportunity comes and something happens where someone who was handling your money needs some money then you know if they take that turn to become dishonest you're probably not going to detect it because you have in your mind everything is working great you know that's that's usually how it happens most of the time when people call me it's because they've observed something or they've read something and you know you got on a course they read something they read something I've written they read something somebody else is written and they said hey that's me you know I know no call and I'll go through the discussions with them but to be honest with you Howard you know I can sit down talk to a dentist for half an hour and at the end of a half an hour say you know I think you know there's probably a good chance your being stolen from or you know what your problems are somewhere else you've got problems elsewhere and you know.

Howard: What do you mean?

Bill: Well you know they may have their own internal spending problems their own you know they they they have you know their chief complaint is fiscal constraint cash flow constraint I can't make my bills I'm having difficulty paying things and I just and my last office manager just quit six months ago and I got a new one and she just quit now I got another one so there's a lot of turmoil and flux in their lives and they're feeling the ability you know maybe the bank is pressuring it and so what they're looking for is an answer to this and the answer in some cases can be related to embezzlement but in other case that can be related to not business decisions you know I mean there may be overextended they may have lines of credit that are maxed out they're just just you know things have happened in their practice that have caused this to happen but they're not related to dishonesty they're related to other things you know management style inefficiency things falling through the cracks you know and then there's the unexpected stuff that happens as well right you know that you can't predict so.

Howard: So what is you know like you go to McDonald's order a hamburger Franco what would do the top three hamburger fried coke ways your dentists are getting embezzled from?

Bill: You know so I'm gonna break it into a few components here and you'll hear some people say you know there's there's thousands of ways to steal or hundreds of ways to steal Howard there's really...

Howard: That's your lover there's a hundred ways to leave your lover.

Bill: Oh right yes I see yeah yeah

Howard: You got to redo that song a hundred ways to leave your lover embezzle from your dentist cuz I really like that I really like that how to steal from a dentist that blog you put up on a fraud Buster's oh is 50 ways to leave your lover.

Bill: That's right Paul Simon yep it is slip out the back Jack.

Howard: Yeah

Bill: Yeah so you know there's it depends on the functions that this person has but I'm gonna tell you the areas that I see predominantly where people will steal right first of all there's over-the-counter payments, payments that come in over-the-counter in the form of an insurance check or a cash payment from a patient or a check from a patient but the theft of checks is less frequent than the theft of cash but I will tell you that people will steal insurance checks and they will convert them into cash by depositing them into their own banks it's easy enough to do and then people may be a little bit surprised by that would you be surprised if I took a check that had Dr. Howard Farran on it for $6,000 and put it into my ATM and nothing happened would that surprise you?

Howard: I think it's crazy that's the way it is.

Bill: Well the reason it is is because there's so many damn checks and unless something is over $10,000 and gets flagged by some anti-terrorism money laundering rule whatever they have as long as the cheque scans properly so the optical recognition system will read the account line it'll read the name it'll read the account number of the person who the check is going to go into your account and it'll read the account number of MetLife it'll look at the date and if the cheque is properly formatted it says this account number is going to put money into that account number and the only time that it's going to fail is if the cheque doesn't meet the optical scan requirements it's not properly formatted like a handwritten check insurance checks are not like that they fly through those optical systems that are perfectly formatted the second one is is if there's an exception if the check is torn or can't be read and that happens very rarely and the third one is if the check is NSF so if I write a check to you and it's NSF that optical system is gonna kick it out there's gonna be a person come down and examine it other than that it's gonna fly right through.

Howard: NSF is non-sufficient funds.

Bill: That is right non-sufficient funds a check bounces around your rubber check as they call it right in any case those things don't happen with the insurance company so people will take checks and deposit so it's the over-the-counter payments so they'll steal cash or insurance checks or money orders and those sorts of things and when you take a payment someone's making a payment to a dental office you know you presume that the services were rendered we're not talking about insurance over Billings when you talk about that a little bit earlier but in this case here I'm talking about the doctor does the work somebody pays that are the person at the front desk steals am i that's probably the most common one. The other ones that I see are abusive credit cards people will have supplies with vendor they'll or they'll have use of an office card and they will use that our regular is what we'll do on author readings or credit cards that you'll probably was a fee you pay a discount rate for your Amex and your Discover and your these stuff you probably use payment and thurman errors or chase the pros credit cards in your progress people come through pay you $5,000 video takes a percentage 2% and you get the rest right that's their that's the processing fee so if you look at a merchant service statement you'll see you know I charged 10,000 to visa and visa pay me 1,500 well that $100 is what you paid visa to let them process your fees so it's called the discount rate and your zoom you're familiar with that and the discount rates vary depending on the card represent two percent whether the card is presented what this fairly crafty office manager did was on the first of the first business day of it month because the doctor had a discount rate with MasterCard at the time of his discount rate with MasterCard was like two percent and visa was 1.75 it doesn't matter what the discount rate was it was a percentage about one and a half to two percent every month she would print off the last month since she would say last month we did fifty thousand and visa and fifty thousand and MasterCard just using that as an example she would then multiply that by the discount rate so fifty fifty thousand times discount race it was $1,000 in merchant fees that were to be deducted she would take both of her cards on the first business day MasterCard and Visa and refund the amount of the discount back to her card thus making a payment now those refunds every month that she made were in the range of about nine hundred dollars a visa and about six or seven hundred dollars a MasterCard because MasterCard wasn't used as much so about fourteen hundred bucks a month the dentist went and questioned her one day and said what are these refund amounts and she said that's the discount rate you pay two percent the visa and you pay whatever to MasterCard and he okay I got it and he and and was satisfied with that explanation it wasn't until sometime later that that explanation started to concern him and sure enough that we found out that this is what she had been doing so another way is for your staff to do refunds back to their own credit cards so any doctors listening right now the solution is simple to stop it.

Howard: So break that down so what does my homie do so if they have an intuition do they go to Hiltzandassociates.com do they call you do you log in through the internet into Dentrix, Open dental to walk them through the process, if someone's calls right now I'm saying man I think my office manager stealing.

Bill: Well the first thing is you know just just go to my website and by my podcast comes out it'll be dentalfraudBuster.com or Hiltzandassociates.com you'll find me on the Internet there's a place there that says contact me or you can book a free consult generally I'll take a half an hour or an hour to sit and go through anybody's questions and concerns the distinction is not like an attorney where I'm gonna chase ambulances I don't want to try and upsell you services that you don't need so if you have a concern and you're saying you know I just saw this was refunded yesterday on a credit card because I had talked about credit card refunds and now I get a call when someone listens to the podcast they're saying I see a refund going back on my credit card you know I think I need you to come in and do an audit I'm gonna say no I mean I want you to do these and I'm gonna tell you what specifically what to do to check that out and then if that comes back it's triage really then let's go to the next step, so if someone has if someone has concerns of employee dishonesty the first step is a conversation with me to triage those concerns if those concerns are well-founded then the next step is to do an examination the same thing that you do in dentistry and medicine you listen to the complaint and you do an examination to try and understand what the underlying etiology is of the complaint are the symptoms in some cases I have said to you I'd say about half of the people that contact me I tell it they don't come back at that they don't engage my services because they needed something else their concerns or valid and I do that through a process of asking questions and exploring so and every situation is different you just need to ask the right questions to see. Now if those questions all come back and it is indicated that there seems to be reasonable grounds that there's a possibility there's a real possibility that what we're looking at here could be employee embezzlement then what I'll do is I'll do what I call a diagnostic examination or an exploratory examination and essentially that's going in and doing an audit a mini audit to look to look at areas where embezzlement may occur.

Howard: Is that online or physically?

Bill: I don't need to be physically I've been doing this since 2004 and I had to go to court twice and I've had to visit practices probably about two or three times in which I will do but it keeps the fees down right so you know and all of this stuff can be we're in an electronic world now so access to the practice management software the bank records a merchant service care credit statements collection agency reports all those things can all be brought in electronically you know all your QuickBooks stuff right and I've got a cloud server where people just put all that stuff in and then I sit back and analyze it but to go back to the exploratory exam the exploratory exam is not like a comprehensive oral exam where you're looking at every tooth and every service and you're doing the pareil probing and you're getting a full map of everything the exploratory exam is to basically say you know is there something here so the analogy would be you know you think there's a mass grave in your practice and you're gonna hire me to come in and dig up a few bodies to prove it and then I'm gonna tell you where the grave is and how many bodies are still buried in there so and most people get that analogy they do all right so and so here's here's how I work if you if we do the exploratory exam what I'm gonna do is I'm not gonna come back and I say yep we've just found fraud and here it is it's been going on for five years and here's the magic number no I'm gonna come back and I'm gonna say here I found some examples I found X dollars I found five thousand or three thousand here are some that I've confirmed and here are some that look like it so you know the probability so these are confirmed as embezzlement and these haven't been confirmed yet but they're consistent with what I found at that point in time you know then you got to make a decision whether or not well a lot of different decisions first of all if the employee is no longer working there you'd make a decision about recovery and prosecution what do you want to do how big is it and the exploratory exam would assess that it would say you know whether this is an acute instance I think this could be a twenty thousand dollar mishap for you or this could be a three hundred thousand dollar mishap so depending on what those numbers are depends on somebody's pension or propensity to seek recovery and prosecution and whether recovery is going to be through civil or criminal means or through employee dishonesty insurance I'll help doctors do all of those things but again the first step is you know you've you've got to ask the question and no question is too silly to ask so one of the things that I do find about working with dentists and you know I like working with dentists I really do and I've been been working with them for many many years is that and I don't put you into a stereotype here but many of them I would characterize as introverted and they will give everybody a second chance a third chance and a fourth chance before finally saying themselves I've got to do something about this right I've had doctors call me and they'll say and I think my employees stealing and I'll go through it and five minutes into the conversation to say well you know I caught her stealing five thousand dollars last year but she said she wasn't going to do it anymore those kinds of things so often times it takes a lot for someone to pick up the phone they don't want to do it they don't want to ask that question because they don't want the answer is it self doubt they don't want to think bad of somebody they don't want to think that their office manager who whose kids are friends with their kids and let's just down the block and they're all in the PTA and you know they all see each other every day at the local AMP they don't want to think that that could be happening therefore they will dismiss an opportunity to ask that question.

Howard: I love I mean I mean they go to school for eight years to help you with your hand their hands do surgery get out of pain there are great guys they're really they're highly educated I love me that they love history but I just my only beef with dentists they just they never know their numbers I loved your opening quarters the best opening ever dentists look at numbers the same way accountants look at teeth yeah that's my homies, they want to they just want to go in the kitchen and cook root canals. You just said on the air you just said that in a month or before this goes live that dentalfraudBusters.com is gonna go live are you gonna are you gonna start using that as your name or you just keep doing Hiltz and Associates?

Bill: No Hiltz and Associates is the company that's the company that does the billing that's the company that the services are provided through dentalfraudbuster.com is my bill helps me my own personal blog where I'm gonna put up my articles musings and postings and do it in a in a format that dentists can go in and get the information that they need. You know one of the things that I've often found out that I that I find I want to break down what I call the fear uncertainty and doubt factors in dentists Minds again going back to nobody wants to think that I mean look the first thing dentists go is the first first thing a dentist sees when he goes in in the morning is who goes in is the chair ready the tray is set up and then the patient comes in and the first thing they say is I hate dentists right you know when you work in a profession like that you know it's very hard for you to overcome the ability to challenge and go out and what I'm saying is that you know you don't want to thank bad people you already have you know trying to make all your patients happy and you can't make them all happy because some people just they just don't like dentists the stereotype so they're reluctant to pick up the phone that's the biggest problem that I see for doctors particularly young dentists when they're starting out and you know I've never had I'll tell you I've never had a young dentist opened a brand-new practice hire somebody new and he starts sealing from day one unless they're experienced and they were stealing somewhere else but if you're a new doctor and you just opened your practice and you know you're it's a new start a new start up and new patients are coming through the door you didn't buy a practice if things are pretty lean you know it's not until your day starts getting full and your schedule is full you know and at the end of the day you're trying to squeeze people in it's when you get busy and you're sequestered into that eight-by-ten room in the back Howard to make this comment cuz I know we're probably gonna be soon run at a time but if you want to open a Starbucks franchise or you want to open up any type of franchise what do you do you you throw your million dollars on the table so you can open up a Starbucks franchise you go to Starbucks and then they train you and guess what you're a barista and you're gonna be out on the you're gonna be out on that front line learning how Starbucks works and how to make coffee and how to do everything right because that's how you're going to be trained any type of McDonald's food franchise you know how to do every job before you become the owner you understand it that's not like dentistry you graduate school you hire a bunch of people and then they put you in a room out back and tell you to stay there all day and you soon realize that if you're not back there all day with your hands within gloves the business doesn't make money so you're motivated to stay in that room and completely disassociate yourself from what goes on at the front desk in fact a lot of doctors would rather not hear about money would rather not discuss those financial arrangements they just want to do the dentistry. So there's no other profession uniquely like dentistry perhaps the nearest parallel will be medicine where doctors don't come into the profession by a dental practice and the first thing they have to do is sit and do a receptionist job or front desk job for a month to learn what it is they don't do that right every other business owner small business owner does that guarantee they know how to do it all because it's their business dentists don't have that luxury they don't have that accommodation and I think that's one of the reasons why embezzlement and fraud is at a higher rate than you see in most other organizations.

Howard: Well on that note it was so if you're feeling that intuition if you got a question he can do this all digitally you can do this remotely go to hiltzandassociates.com within a week you might be able to go to dentalfraudbusters.com that might be easier to remember DFB dentalfraudbuster.com His name's Bill Hilts it's Hiltz he's in Halifax Nova Scotia Canada bill thank you so much for coming on the show today my homies fight embezzlement.

Bill: Good alright no worries, thank you very much for having me.