Even with separation of duties, I find the lack of proper business oversight of internal practice controls astounding. In any position held with personal financial responsibility, you shouldn’t just welcome oversight over internal controls; you should intentionally structure and provide it.
But in physician practices, I have usually discovered that they have a "long-time, trusted" employee who manages the bank accounts, payroll, the company credit card and accounts payable with the sole oversight being that the doctor(s) who sign the final checks. The signing of checks is usually done during some meeting and are signed just as fast as they can – you would think they were EKGs!
It seems that to even suggest that the administrator should supervise the internal controls of a medical practice, review the details of these accounts and ask questions means you're "not a team player." And God forbid that you notice a bill and then try to save money by changing vendors or just asking for competitive quotes – – -
I know someone’s son who is involved in strategic military security – I think I prefer their motto – "VERIFY".
But, hey, it's their money…