Protecting Your Assets: Embezzlement in Orthodontics

Wendy Askins, BS, MBA
February 8, 2023
5 min read

Protect Your Practice's Assets: Embezzlement in Orthodontics

Tops: How prevalent is embezzlement in the dental profession? Are orthodontic specialists more or less vulnerable than other specialists?

Wendy Askins: Statistics show that approximately 60 percent of dentists will be victimized by some form of embezzlement activity, with an average loss of $100,000. Statistics aside, I personally believe that this number is much higher—especially in orthodontics. The complicated business processes required in an orthodontic office, unfortunately, create more convenience for an opportunistic pilferer.

In addition to the deceptive methodologies perpetrated in a general dental practice, an orthodontic practice must contend with high patient volume, high level of staff delegation, long-term financial contracts, noncontract charges, payment plans, variances in insurance plans, and the application of multiple discount programs.

Tops: You have had clients who use all different kinds of orthodontic practice management software, including several recognizable names. Tell us about your experience when you’ve conducted an investigation for a client who uses Tops.

WA: In thinking about Tops, the phrase that springs to mind is this: The highest form of sophistication is simplicity. The program is simple to navigate, and the required data for investigation is easily extracted via multiple sources.

In designing software and writing computer code, there is a monumental difference between a software programmer with the best of intentions and a programmer with intimate knowledge of what is required in daily operations to help create, maintain, and secure a successful orthodontic practice.

Tops is highly developed and well-thought-out from beginning to end— the end being what I call “the backside” of the software, where I work my magic!

Tops: You said, “Data for investigation is easily extracted via multiple sources.” Can you elaborate?

WA: Most individuals are proficient at the “front side” daily use of their system. When I am examining data files, I search for what cannot be seen—the transactions that a perpetrator has purposely hidden.

This process leads me deep inside the computer code to understand why the transaction occurred and what specific function within the system led to the result. It is a process of understanding the difference between a legitimate transaction, a transaction error, or a transaction that resulted in the “disappearance” of funds.

A successful investigation requires that stored data be thorough—even upon deletion or void—and accessible in many different formats (such as an audit trail, data tables, and/or reports).

“In thinking about Tops, the phrase that springs to mind is this: The highest form of sophistication is simplicity.”

Tops: Which is the most helpful report in Tops orthodontic practice management software?

WA: The Tops Transaction Audit Trail is a beautiful thing! Every financial transaction is recorded with a specific transaction number, date, patient name, and type of transaction. Then the amount of the transaction is recorded in one of seven different columns that represent the end result of the transaction.

Contracts (production) are recorded, along with specifications of the amount of the down payment; positive and negative contract adjustments are recorded; so are positive and negative current balance adjustments.

The specific location and provider is recorded, which is especially helpful in large group practices or to help uncover a “fake” provider who was created and used by a perpetrator. The specific employee’s name and workstation is recorded, which is helpful to clearly identify the perpetrator or an employee who may need more training in a specific area. Deleted/voided transactions are also numbered in sequence and are highly visible, and the data can be sorted to many different specifications. This report is a thorough snapshot of financial activity in one glance. The Tops Transaction Audit Trail provides in one report what can take up to five reports in other software programs.

The entire patient journey in one place

The technology inside your orthodontics practice should work hard for you. Tops’ complete ecosystem gives you the power, speed, and agility to move on to what’s next.

Tops: Have you had the opportunity to work with the Tops team?

WA: I have had the opportunity to work with many software professionals, both within and outside the dental profession. When an orthodontist approaches Prosperident to begin an investigation, he or she is overwhelmed by emotions and confusion. Some of them are fearful because their business is on the verge of financial ruin; some of them are heartbroken because they have just become suspicious of a trusted longtime employee, and they are anxious and bewildered.

One of the most rewarding aspects of my work is to feel a calmness come to my clients when I assure them that there is a solution and I will be able to give them a definite answer regarding their suspicions.

I enjoy working with the team from Tops because they “get it”! Some practice management software companies seem to have forgotten the real meaning of customer service.

If you were a doctor who suspected that an employee was stealing from you on a daily basis, could you imagine the anguish of having to hear that you have to write two separate request letters, be passed around to three different departments—and then have to wait more than 30 days, while the legal department approves your request to allow an investigator access to your patient database?

With Tops, a doctor would simply contact a member of the Tops support team to authorize Prosperident to access their patient database via a “fingerprint.” The relationship that Tops has with its clients makes this a smooth process, and clients are so grateful for the simplicity.

"The Tops Transaction Audit Trail is a beautiful thing! Every financial transaction is recorded with a specific transaction number, date, patient name, and type of transaction.”

Tops: Can Tops practice management software eliminate fraud and embezzlement?

WA: A comprehensive software program such as Tops is certainly an asset. However, no software program, CPA, protocol, or consultant can entirely eliminate fraud and embezzlement. Most fraudsters are highly intelligent and are keenly aware of policies and procedures, as well as the reports used to reconcile by the doctor or bookkeeper. In some cases, the money goes straight into the perpetrator’s pocket before any record of the payment is made.

Think of embezzlement as a rushing body of water in which you place a large tree to stop the flow. The flow of the water will slow as it moves around the obstacle, but then eventually, the water will meander to a path of less resistance, and the flooding begins again.

In one case, the perpetrator would issue handwritten receipts for cash payments, then would utilize every single adjustment code in the computer system to reduce the patient’s current/contract balance. She even took advantage of the practice referral program, in which a $100 courtesy discount was deducted from the patient’s account if they referred a friend for treatment. The illegal activity continued for four years until the orthodontist became suspicious of unrelated activity.

There is no computer system that can detect or prohibit the fraudulent use of legitimate functions of a computer program. This is why it is critical to have well-developed formats such as an audit trail, data tables, and/or reports.

Tops: What else should orthodontists know about fraud and embezzlement?

WA: It is improbable and impractical for an orthodontist to conduct daily forensic accounting procedures.

Over the past few years, we have seen an increase in the complexity of schemes and methodologies used by fraudsters. However, one consistency that does remain is the behavior that perpetrators exhibit.

Prosperident has developed an Embezzlement Risk Assessment Questionnaire, which can help to identify these behaviors. To obtain a complimentary copy of the questionnaire, please email

If you currently have suspicions, please do not ignore the warning signs. Embezzlement investigation is not a do-it-yourself project. Please seek expert help.

About Wendy Askins

In addition to her MBA and undergraduate studies in psychology and criminology, Wendy Askins has more than 20 years of experience in the orthodontic specialty. She currently serves as the supervising examiner of Prosperident’s Orthodontic Specialty & Oral Surgery Departments.

Prosperident is North America’s leader in the detection and investigation of frauds committed against dentists.Wendy can be contacted at +1 (888) 398-2327 or

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