Fraud Prevention Starts with Your Software

When Trust Goes Wrong: How to Build Safeguards in Open Dental to Prevent Office Fraud

Internal fraud isn’t just a big-city problem… it happens in small, trusted practices every day.

This one stopped me cold.

A Florida office manager was sentenced to 15 years in prison for defrauding two dental practices out of tens of thousands of dollars. She had patients leave the “Pay to” line on checks blank, filled in her own name, altered payment amounts, and even used a doctor’s DEA number to prescribe herself controlled substances.

All while sitting in a trusted position inside two offices that thought they had it handled.

Wild, right? But here’s the truth… this isn’t rare. It’s just the one that made headlines.

And what really stood out to me was how easily she used a doctor’s DEA number. That tells me the software setup, not just the people, failed those practices. Because when Open Dental isn’t built out properly, the door stays wide open for this kind of thing.

You can’t control every decision someone makes, but you can build your Open Dental system in a way that makes fraud nearly impossible to hide.

Let's talk about how.

1. Start with Security Permissions That Actually Mean Something

Too many practices give admin-level access to everyone from the doctor’s spouse to the newest assistant.

Permissions are your first line of defense.

Each role should have its own security group. Keep providers, billing staff, and front desk team permissions separate. If someone doesn’t need to delete payments, they shouldn’t even see that button.

Even a quick 5-minute review can reveal a pattern before it turns into a loss.

2. Require Provider-Specific Logins

Every provider, hygienist, and assistant should be logging in under their own credentials.

That means the person writing prescriptions is the one whose DEA number is tied to the action, not whoever’s name happens to be in the dropdown.

The person who takes payments should not be the same person who posts them.

Yes, it takes a few seconds longer to switch users… but it can save you thousands in stolen funds and headaches.

3. Lock Down Payment and Adjustment Protocols

Refunds and adjustments are two of the most commonly exploited areas in dental software.

Create a written policy that defines when each should be used, and make sure your team understands the difference. Refunds should go through accounting approval, and adjustments should require documentation in the patient note.

If you see adjustments that don’t make sense, trace them back. Every single one.

4. Audit Unearned Income and Overpayments

Unearned income is one of the easiest places for money to hide. Make it part of your monthly routine to audit these balances.

If your unearned or credit balances are constantly climbing, dig in. Cross-check patient accounts for refunds, and verify they’re legitimate.

Remember, your goal isn’t just to catch fraud, it’s to make sure your reports tell the truth.

5. Review the Security Log Regularly

Even if you trust your team completely, trust your system more.

Open Dental tracks every change in the Audit Trail (Setup > Security > Audit Trail).

Review this log weekly or at least monthly to spot red flags, things like deleted payments, changed claim statuses, or altered insurance checks.

When you know what “normal” looks like, anything out of the ordinary becomes obvious fast.

When systems are transparent, accountability feels safe… not punitive.

You’re not looking for mistakes, you’re building a culture of honesty and accuracy.

Final Thought:

Internal fraud doesn’t happen because someone “got lucky.” It happens because systems left room for it.

Building clear permissions, defined policies, and consistent audits isn’t overkill… it’s leadership.

Protect your numbers, your reputation, and your peace of mind.

👉 Schedule your Comprehensive Software Exam

Protect your practice before something like this becomes your headline.