I'd been in solo practice for several years when my longtime receptionist announced she was leaving. My wife, who was my office manager at the time, called a temp agency for someone to cover us while we hunted for a replacement. They sent us Shirley, a 24-year-old who was single, living at home, and taking evening classes in accounting.
Shirley proved to be a quick study, with an extraordinary knack for numbers. She quickly memorized the CPT and ICD-9-CM codes I commonly used. She remembered important details about patients and their families. And she balanced day sheets to the penny.
After observing Shirley for two weeks, it was obvious that we didn't need to look any further for a new receptionist, so I offered her the job. After several weeks of training, my wife checked her work and found no errors in her coding, insurance filing, or recording charges and payments.
A few years later, my wife decided to reduce her role in the practice, and I promoted Shirley to take her place as office manager. Shirley worked hard at handling collections, mastering our managed care contracts, and converting our practice to a new computer system. Her performance was exemplary. In fact, she was so devoted that she never left the office until her work was done, and rarely took any vacations. (I later learned that office thieves typically don't take time off, fearing that in their absence someone else might look too closely at their work.)
Working at home, my wife continued to do most of the bookkeeping, and oversaw Shirley's day sheets. After several weeks without finding mistakes in Shirley's work, however, my wife decided her supervision was a waste of time. Shortly afterward, my wife accepted a four-month fellowship in another state. During her absence, I took over the payroll and deposits, but no one audited the day sheets. Shirley continued to post charges and payments, and prepared the deposits.
We finally discover the truth
Shirley had been office manager for about a year by the time my wife returned from her studies. She inquired about the practice finances, so I brought home some day sheets. When she examined them, she immediately found discrepancies. The cash deposits were only a fraction of what they typically ran. There were obvious differences between what patients had paid in cash, as recorded on their superbills, and the cash totals on the deposit slips.
Concerned, my wife went to the office late that night and checked the computer. She found that some of those copayments had been adjusted to insurance writeoffs or to professional courtesy. She also found that office visits for some self-pay patients who'd paid in cash had never been posted. Alarmed by then, my wife re-examined the day sheets dating back to the time Shirley became office manager. She found small cash amounts missing: $5 to $10 a week at first, but growing to about $200 a week. We estimated the total loss at roughly $10,000 over the past year.
To confirm her suspicions, my wife called four patients who had paid cash the previous week. Explaining that she was the bookkeeper, she asked them what amounts they had paid, and if they had received receipts. All of them sent copies of their superbills and receipts to our home. Sure enough, the amounts on the receipts were much more than what Shirley had posted on the day sheets. For example, with a cash patient who had been seen for both office visit and venipuncture, Shirley had recorded only the venipuncture. Although the patient had been charged and had paid $60, as recorded on the superbill and receipt, Shirley had entered only $10 on the day sheet, pocketing the remaining $50.
We were shocked at this discovery. By then we'd known Shirley more than six years. She'd been an occasional guest in our home, and our children loved her. We'd even lived through some emotional incidents with her, including a death in her family. I wasn't angry, just very disappointed to discover that someone I had trusted had violated my confidence.
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Shirley seemed like the perfect office manager, until we discovered she'd stolen $10,000.