• The six core payment controls to implement.
  • Refund and front-desk safeguards to block scams.
  • Tight access and real-time alerts to keep payroll safe.
  • A 30-day rollout plan to operationalize breach prevention.
  • Key metrics to track to strengthen your defence.

Healthcare clinics move large, predictable sums of money every day. From payer EFTs and patient payments to adjustments and refunds, the volume and consistency of these transactions make operating accounts attractive targets for criminals. A bank detail change or unauthorized debit might easily slip through the cracks, draining operating cash and disrupting payroll.

The number of healthcare organizations losing over $200,000 to cyberattacks has quadrupled between 2024 and 2025.[1] Clinics should not take cybersecurity measures lightly. The good news is that a few strategically-orchestrated bank controls and simple front-desk routines may block many common attacks. Here's how to protect your clinic from becoming a statistic.

Top Six Core Payment Controls for Clinics

Set up these simple but effective treasury controls with the help of a business banking professional like PNC:

1. Reduce the Number of Checks Processed

Paper checks are one of the highest-risk and least visible payment methods. Reducing check volume may help lower exposure to altered payees, counterfeit items, and mail interception. Instead of checks, encourage the use of electronic payments for vendors, refunds, and internal transfers wherever possible.

2. Use a Positive Pay Solution

If you must pay with checks, use a Positive Pay solution to help prevent altered or counterfeit checks from posting. You submit information about the checks you've issued to the bank, which verifies the amount, check number, and payee before clearing them. You may review exceptions online and stop altered or unauthorized checks before funds are drawn.

3. Transition to ACH Payments

ACH payments offer greater control and traceability. Implement dual approvals (i.e., separate the duties of creating and approving a payment) and ACH filters or blocks to reduce manual handling while minimizing the risk of unauthorized disbursements. Additionally, set a dollar threshold for high-risk items, like large refunds or vendor payments, and require a second approver.

4. Enhance Controlled Disbursement Process

Controlled disbursement is a corporate cash management service. Your bank provides early daily notification of all checks clearing an account, improving cash flow visibility. Clinics may anticipate cash flow needs and identify unusual transactions as they occur. With the median duration of fraud being 12 months, catching suspicious activities early is essential for minimizing damage.[1]

5. Update Policies, Technologies, and Internal Controls Regularly

Security controls are only effective if they align with current workflows. Conduct periodic audits of your financial functions and perform background checks on employees. Also, implement dual control for drug, lab, or supply ordering; protect credit card terminals and check stock from unauthorized personnel; and track your finances with online reporting and reconciliation technologies.

6. Implement Comprehensive Payment Security Training

Your front desk, billing, and finance teams are your first line of defense. Ongoing, role-based training helps them reduce errors, recognize suspicious requests, follow verification procedures, and escalate concerns quickly. Educate your employees to watch for these red-flag behaviors:

  • Living lavishly beyond their means.
  • A recent divorce, money issues, or family problems.
  • Unusually close associations with vendors or customers.
  • Control issues, such as unwillingness to share duties or locking their desks.
  • Bullying or intimidating other employees.
  • Refusal to share duties or train others.
  • Irritability, suspiciousness, or defensiveness.
  • Not taking days off, working nights or weekends when others aren't present.

Implement Refund and Front-Desk Safeguards

Refunds are among the more common forms of exploits in clinics. Here's how to lower your risks:

  • Standardize your refund flow, for example: Eligibility check → batch approval → disbursement (RTP®/same-day ACH for speed) → automatic patient notice. Keeping refunds in a batch flow reduces errors and prevents opportunistic breaches.
  • Conduct verification before issuing a refund by matching the patient ID, date of service, and original payment method. Also, require a second review for out-of-pattern cases (e.g., large refunds and cross-card requests).
  • Follow card-not-present (CNP) hygiene and use AVS (address verification) or CVV checks. Implement a verification process for mismatches or high-risk signals. Also, keep receipts and descriptions to minimize chargeback risks.
  • Ban email-only requests to prevent vendor or payer bank-change scams. Instead, call a known number (not the one in the email) to verify new or updated account information and log the details in your system.

Protect the Payroll — Your Clinic's Heartbeat

A stable and secure payroll is central to your clinic's operations. Fund payroll a business day early and maintain a modest operating buffer to avoid last-minute scrambles. Document cutoff times, approval windows, and backup approvers to ensure consistency.

Set up an "emergency lane" — a controlled, dual-approved option for exceptions. For example, same-day ACH and pre-approved wire templates help address last-minute corrections while avoiding free-form, high-risk payments. You should also tighten access control by enabling multi-factor authentication (MFA) and allowing only finance leadership to add payees or change bank details. 

Finally, turn on real-time alerts for the payroll window for first-time payees, high-value debits, and changes in user permissions. This safeguard gives leadership immediate visibility into unusual activities.

A 30-Day Rollout Blueprint and Success Metrics

Follow this four-week implementation plan to set the foundation for long-term success:

  • Week 1: Enable the "Big Six" controls and identify roles (e.g., who creates and approves a payment). Also, turn on alerts and ensure they're routed to the right people.
  • Week 2: Publish a one-page refund standard operating procedure (SOP) and front-desk script. Set refund-velocity alerts and test one refund instant end-to-end to verify the workflow.
  • Week 3: Run 20-minute drills like "urgent vendor bank change" or "Friday refund deluge." Capture lessons learned, educate your staff, and refine your processes.
  • Week 4: Perform a user-access review and remove stale logins. Also, document log locations, alert settings, and exception decisions for future reviews.

Don't forget to track how these measures perform. Note exceptions stopped (e.g., by Positive Pay and ACH filters), refund cycle time, chargeback ratio, alert response time, and payroll success rate to inform continuous improvements.

Build a Risk-Resilient Clinic Without Adding Complexity

Fraud prevention doesn't have to be overwhelming or expensive. The right mix of treasury controls, front-desk safeguards, and clear payment procedures may be able to help you nip common attacks in the bud. By tracking a few key metrics, you may strengthen your processes over time for faster and safer operations.

A trusted banking professional with extensive experience in the healthcare sector, like PNC, may be able to help you tailor and implement various security measures to support your operations. Book an appointment with our business banker and explore ways we may be able to help you fend off threats.