discover fraud should I let an employee go?

**Mandy** · 12-24-2006, 07:21 PM

I have had an employee working for me for years. I have always been very strict with respect to not defrauding any company. Sometimes patients ask that claims be made under another family memebers name who may have coverage, or ask that the date be post dated or ask that the pair of sunglasses be written up for prescription eyeware. I have always stood firm and the answer was NO. Last week I found my assistant had made a claim and submitted an insurance claim for herself. In fact there was not even a purchase made. She simply had some unused benefit which was about to expire.

I have already confronter her and indicated my disappointment in her action, especially since she was aware of my office's standing in the matter of false claims.

Now is the question what to do. Would you let her go? Ask her to resign and submit a letter indicating her sole involvement in the manner? Inform the insurance company?

As this is the first offence (that I am aware of) I would like your opinion and like to hear if you have had similar experiences.

Thanks in advance. Mandy-- and have a Merry Christmas

**chip anderson** · 12-24-2006, 08:57 PM

Get rid of her unless you want to share a cell with her.

**Scott R** · 12-24-2006, 10:47 PM

As this is the first offence (that I am aware of)

How many until youre both in hot water. Kill it when its small

**GOS_Queen** · 12-25-2006, 11:15 AM

Definately get rid of her.

**karen** · 12-25-2006, 12:55 PM

What did she say when you asked her why she did it?

So she pocketed the payment from the insurance????

**Mandy** · 12-25-2006, 03:16 PM

I discovered some deleted invoices when looking at some "end of day postings" The invoices were in her name, printed then deleted. She indicated that her husband has some unused vision care benefits. She wrote up a invoice for contact lens purchases, (She doesn't wear contacts) submitted it to the insurance company. The cheque has not arrived yet. She asked that the cheque be sent to "the supplier" (which is me) I asked what she intended to do with it. She said she was going to order a pair of sunglasses of equal value to the contact lens invoice she sent in. The vision care benefit did not cover non prescription sunglasses so she made it out for contacts.

If this were your office - what would be your next step?

Mandy

**Jacqui** · 12-25-2006, 04:40 PM

FIRE her !!!! FAST

**Golfnorth** · 12-25-2006, 04:46 PM

Originally Posted by Mandy

I discovered some deleted invoices when looking at some "end of day postings" The invoices were in her name, printed then deleted. She indicated that her husband has some unused vision care benefits. She wrote up a invoice for contact lens purchases, (She doesn't wear contacts) submitted it to the insurance company. The cheque has not arrived yet. She asked that the cheque be sent to "the supplier" (which is me) I asked what she intended to do with it. She said she was going to order a pair of sunglasses of equal value to the contact lens invoice she sent in. The vision care benefit did not cover non prescription sunglasses so she made it out for contacts.

If this were your office - what would be your next step?

Mandy

Hi Mandy;

Sorry that you have to deal with this. I'm sure that the situation has taken the edge off the holdiay season for you.
I believe the events have told you alot about her character and ethics.
I run my business the exact same way you do I applaude you for it.
I would ask her to resign and admit to the fraud in her letter of resignation. I would also advise the insurance comapny in question. I assume that you have the hard copies of the incident for proof to the insurance companyand/or labour board. If she refuses to resign I would let her go.

Best of luck!

**karen** · 12-25-2006, 10:08 PM

First of all, I think you should let her go. Unless because of your long term relationship with her you know something about her that we don't.

I always find myself curious as to what people are thinking in these situations. If she knew your policy, why did she do it in the first place and when the heck was she going to tell you? These are the kinds of questions that don't really matter but I wonder about anyway. Sounds like she knows how to work the system. I wonder if she has done this other places? It sounds like the way you are describing it she does not seem very remorseful or alarmed at your discovery....insurance fraud is pretty serious.

**Ph0t0n** · 12-25-2006, 11:38 PM

1. Ask her to resign and admit to the fraud in her letter of resignation. You don't want to be paying unemployement benefits to this person.

2. If she wont write the letter/sign the resignation letter, then tell here you are immediately advising the insurance company as well as the local police fraud department.

The No.1 small business mistake is NOT getting rid of employees that should be gone.

**GOS_Queen** · 12-26-2006, 09:37 AM

Originally Posted by karen

I always find myself curious as to what people are thinking in these situations. If she knew your policy, why did she do it in the first place and when the heck was she going to tell you?

I agree - except I'll add that I don't think there should be a NEED for a policy - (sigh)

whatever happened to common sense and ethics?

**GOS_Queen** · 12-26-2006, 09:38 AM

Originally Posted by Ph0t0n

1. Ask her to resign and admit to the fraud in her letter of resignation. You don't want to be paying unemployement benefits to this person.

2. If she wont write the letter/sign the resignation letter, then tell here you are immediately advising the insurance company as well as the local police fraud department.

The No.1 small business mistake is NOT getting rid of employees that should be gone.

Excellent point!

(I still would do #2 whether she signed it or not)

**Mandy** · 01-13-2007, 11:25 PM

As a follow-up to my original post you may have wondered what was done.

I consulted the College and was advised to return the cheque to the insurance company indicating "the claim should not have been sent".

I indicated to my employee on the first day back in January that as a result of the fradulent claim made in December that I was intending to return the cheque to the insurance company when it arrived.

The following day the employee in question resigned.

I guess as a lesson learned, I come away from this realizing that I cannot simply allocate my time to my exam room, believing that the front office is running as it always had and should. Rather I will need to spend some time doing an assessment of claims made on behalf of my staff, for themselves and patients, on an ongoing basis.

Thanks for your input. Mandy