Accountability: Nine Ways to Protect the Physician and the Manager


Recent news stories about manager embezzlement give us all a black eye.  What can managers do to limit their liability, and how can physicians protect the practice without managing the day-to-day operations themselves?

Here are nine suggestions:

  1. Perform a thorough background check before hiring a manager, and have your manager bonded.
  2. Have your bank statements sent to the physician’s home address and/or make sure the physician has the master access to the bank accounts online.  Physicians, have a personal relationship with your practice banker and make time for a short meeting with them quarterly.
  3. Have the physician sign your practice checks. Each check should be attached to an invoice that lists the goods or service purchased.  Do not order a rubber stamp of the doctor’s signature.
  4. Insist on a duplicate, numbered receipt book for staff to give receipts to patients for all over the counter payments.
  5. Have your insurance and patient checks sent to a lockbox.
  6. Make sure the manager takes time off ”“ at least several weeks a year. Managers who are “too busy” or “can’t ever get away” are a red flag.  The physician should review all mail during the manager’s vacation.
  7. Check the monthly credit card statement carefully before making the payment.  Keep the card restricted to a relatively low limit to manage your liability.  Do not pay practice bills routinely on the card to build frequent flyer miles as this makes it much easier for an employee to hide non-approved expenditures.
  8. Have a budget and make sure variances can be explained.
  9. Hire a CPA to review the books quarterly.  Even if you do not need the services of a CPA for your statement reconciliation, taxes or partners distribution, hire one to review the expenses and receipts, and ensure that the retirement plan is being funded appropriately.

A qualified, ethical manager has nothing to hide and will thank you for following these nine rules.  The rules protect the manager as well as the practice.

Photo credit: © Yuyang |

Posted in: Finance, Physician Relations

Leave a Comment (4) ↓


  1. Lee Larocque January 9, 2010

    Mary Pat…
    We have acquired another practice that is located two-miles from our own.
    Their provider (without his office staff)will be seeing his own patients in our office for the next three-four months until his official retirement date of May 1st.
    What do I need to do regarding medical records, insurances, billing, etc.?

    • Mary Pat Whaley January 10, 2010

      Hi Lee,

      Thanks for your question.

      My advice depends on your specialty and payer mix and whether you are using paper charts or electronic medical records.

      For instance, I would suggest something a little different for a pediatric office than I would an internal medicine practice. I would give different advice for a practice on paper charts then I would on EMR. Woud you give me a bit more information, and I will give you some options for your transition.

      Please email me at

      Best wishes,

      Mary Pat

  2. Michelle July 19, 2011

    Could you give me a reason why a medical practice should have all receipts written out for each patient?
    I have an office manager that things that I am going to far to have the staff write out a receipt for each patient. Dr. wants me to give him an example or scenario.

    Thank you,

    • Mary Pat Whaley July 19, 2011

      Hi Michelle,

      Receipts are required for cash payments, as that is the most common and easiest way for embezzlement to happen in a medical office. For patients who pay with checks, their canceled check is considered their receipt. Receipts for credit or debit card transactions are common, although many systems now allow receipts to be send via email.

      It used to be true that the physician signed the encounter form (superbill, charge ticket, etc.) and the patient signed the encounter form to prove the patient was there and the care was provided and that form also served as a receipt, however many practices only supply a copy of the encounter form upon request.

      So to answer your original question, I personally do not know why a receipt should be written out for each patient, unless the practice has been embezzled in the past and this is the way they are protecting themselves. It would seem that writing out receipts for every patient would be time-consuming and inefficient, but there’s always more to the story…

      Thanks for writing and

      Best wishes,

      Mary Pat