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Ask Dr. Christensen

Dec. 1, 2009
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers.

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question
to Dr. Christensen, please send an e–mail to [email protected].

For more on this topic, go to and search using the following key words: embezzlement, fraud, financial responsibility, product ratings, product research.

Q Recently, I discovered a front office employee had embezzled about $75,000 from my practice over a period of FIVE years. I had no idea that she was dishonest. In fact, she and her family were personal friends. We had them to our home for dinner on various occasions, and her children were close friends with my children. I have learned many lessons from this experience, and with great anguish, I had to fire her and report her to the police.

However, my questions for you are: In the future, how can I identify a potential embezzler, and what do I do if I feel it is happening again?

Where is that cash going? Is this an honest employee or not, and how do you tell?
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A Having experienced embezzlement a few times myself over my long career, your story is not new to me. The characteristics you have described about your employee are commonly those of an embezzler. The embezzler is typically someone to whom you have trusted and delegated financial responsibility. Apparently, in this case, she was a trusted friend and associate, the last person you would have expected to be an embezzler. Although it may seem surprising that such an employee would take advantage of you, statistics show that a high percentage of dental practices have had similar experiences.

Recently, Lisa Harris, a nationally known expert on dental office embezzlement, and I produced a PCC educational video on embezzlement and fraud, and I put considerable thought into the questions you asked as we were making this video.

There are observable situations that may indicate you have an embezzler in your practice, as reported by various studies and many experts. The situations include:

  • You are working as hard as ever, but your reported revenue is less.
  • An employee wants to work additional hours.
  • You find that some of your financial documents are missing or incomplete.
  • Your cash deposits have declined in spite of no change in practice activity.
  • An employee often comes to work early or stays after hours to “catch up.”
  • An employee refuses to take time off for a vacation.
  • Large numbers of accounts have had “adjustments.”
  • An employee appears to have more discretionary money for clothes, a car, or other expensive items.
  • An employee resists any changes in computer programs.
  • Financial information is often delayed getting to you or is inaccessible.
  • There is an increased number of financial discrepancies and complaints from patients.
  • There are missing deposits on bank account reconciliation.
  • You note excessive voided receipts.
  • An employee wants to work alone.
  • There are excess purchases you cannot identify.
  • You note some vendors that you cannot identify.
  • Your general ledger is out of balance.

What do you do if such situations are noted in your office? The first action, before you make any accusations, is to attempt to get some type of solid proof that embezzlement is ongoing. When you have proof, confront the employee. You will probably have a tearful confession, a belligerent denial, or a response somewhere in between the two extremes.

Some employees will vehemently deny dishonesty at first and back down later to admit the wrongdoing. After finding proof of embezzlement, you must decide what to do. Most dentists immediately dismiss the employee from the practice, report the incident to the police, and attempt to find ways to recover the funds. A few practitioners, though, actually keep the employee and let them pay back the money owed to the practice. You must make that decision.

I hope this brief answer will help you to identify future embezzlers. One important lesson is to suspect almost anyone with the above described characteristics until you are convinced they are not embezzling.

Our newest video, V4739, “Protecting Yourself from Embezzlement and Fraud,” shows many preventive methods as shared through the experience of an expert with 20 years of observing and detecting embezzlement.

Q I am very frustrated with the many ads that are present in every journal stating that a specific product is the best in its category, and the fact that many companies claim the same superiority in spite of the self–proclaimed superiority of other products. When I want to buy a product, where do I turn for help?A Your question is one I have been asked to answer many times. Thirty–four years ago, Dr. Rella Christensen and I started a nonprofit product evaluation organization, Clinical Research Associates, now named CLINICIANS REPORT. The purpose of this organization was and is to answer questions like this.

Numerous ways exist for you to get help evaluating products before you purchase them. I will list and discuss some of them.

Most of the major manufacturers perform excellent research on their products before they are released into the market. As you might expect, though, they are going to give you the most positive research reports. After reviewing the manufacturer’s information, check these potential substantiating or rebuttal sources:

Product evaluating groups. CLINICIANS REPORT, then CRA, initiated the concept of independent evaluation of dental products in 1976. This nonprofit, unbiased group is still considered to be the “gold standard” in product evaluation. Other groups that evaluate products have since come on the scene. You must make your own decision about which group or groups you trust. Concise, short, no–nonsense, multiproduct evaluations — containing basic science and real world clinician evaluations — are what you need to see to support or refute manufacturer claims.

Most dental schools have competent researchers on their staff. Some of them have conducted research on products or concepts in which you have interest. These researchers can help you support your tentative conclusions about specific products.

Your fellow practitioners. Experience gained by your peers who have used specific products is excellent. Contrary to the apparent beliefs of some, evidence–based conclusions require clinical observation as well as scientific projects. In fact, to be reliable, observation and scientific evidence must coincide to prove the answer to any question.

Dental journals are another source; however, often you will see contradictory research reported on a specific subject in the same issue.

The Internet. Various sources of Internet information provide guidance. Among them are: PubMed, EMBASE, MEDLINE, the Cochrane Collaboration, Google, and many others.

Continuing–education courses. Numerous groups such as the Pankey Institute for Advanced Dental Education, Kois Center, Spear Education, and others provide in–depth, hands–on courses that allow observation, use, and decision–making about products. One of my main activities during many years in the profession has been providing continuing–education courses that not only talk about subjects, but that also provide hands–on experience in the subjects being taught. Our group, Practical Clinical Courses, may be reached at (800) 223–6569 or visit

You! The bottom line is you must determine what you want from a specific product, spend the time researching some of the sources listed in this article, and then make a personal decision about specific products.

Confusion about which product is the best is not going to become less. It will probably become more confounded in the future. Learn to use the resources described above to allow you to make the correct product choices. Look for private, nonbiased, preferably nonmanufacturer supported sources that do not gain financially from their evaluations.

For more about this topic and gain CE credits, go to

Dr. Christensen is a practicing prosthodontist in Provo, Utah, and dean of the Scottsdale Center for Dentistry. He is the founder and director of Practical Clinical Courses, an international continuing–education organization initiated in 1981 for dental professionals. Dr. Christensen is a cofounder (with his wife, Rella) and senior consultant of CLINICIANS REPORT (formerly Clinical Research Associates), which since 1976 has conducted research in all areas of dentistry.

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