What happens if your employee steals from insurance companies?
Your employees can steal from insurance companies in the same way, and you can be held accountable (think Dr. Roy Shelburne
Dental employees can, and do, use similar schemes to "milk" benefits from insurance companies.
A problem for dentists is when an insurance company detects false claims coming from your office, they will focus attention on you.
Most insurers will think that you have "dirty hands" and were involved or knew about the thefts.
In order to defend against any allegations or claims, the best approach is to use the "clean hands" approach and clearly demonstrate that you had:
- - No knowledge that your employee was making fraudulent claims
- - you did not instruct or guide your employee to commit fraud
- - you did not consent or authorize your employee to commit fraud
- - you were not "willfully blind" to your employees actions.
In every case** where employees were submitting fraudulent claims to insurance companies, I was successfully able to advocate "clean hands" for my clients to the insurers, which placed the onus and focus on the employee.
**in every case except one , when the dentist really had "dirty hands". When insurance companies started asking questions, I was hired to investigate the office manager, who the dentist claimed was responsible.
It was a smoke and mirrors game, which the dentist lost. I ultimately had to sever my engagement with this dentist.
He was charged, but did not go to prison. He did lose his license for a period of time, paid hefty penalties and moved to a different state where he now practices.