©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethics, Jurisprudence, and the Health Information Portability and Accountability Act Chapter 3

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Law Set of rules established and enforced by government –Local, state, and federal

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Law Criminal and civil law –Charges brought against dentist involve civil law –Criminal law involves wrongs committed against society

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Law Dental Practice Act –Dental team members’ duties and functions as licensed or nonlicensed –Explains what duties are allowed Includes expanded functions –State guidelines determined by each state Identifies grounds for suspension

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Law State Board of Dentistry –Responsible for enforcing Dental Practice Act for its state –License to practice granted when dentist has: Met minimum educational and moral requirements Passed written and clinical examinations

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Law State Board of Dentistry –Expanded functions –Certification, licensure, and registration Some states require that dental assistants are certified, licensed, or registered Continuing education necessary to retain registration or license

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check If a patient files a lawsuit against a dentist, what is the patient referred to in this case? –The plaintiff

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dentist, Dental Assistant, and Law Contracts –Expressed versus implied –Termination

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dentist, Dental Assistant, and Law Dental assistants are agents of dentist Dentist ultimately responsible for actions of dental assistant and liable for their actions and comments –Res gestae “Part of the action” –Admissible in court of law

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Standard of Care Malpractice –Four Ds: Duty Derelict Direct cause Damage

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Standard of Care Tort –Wrongful act that results in injury to one person by another Assault –Threat of touching person without consent

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Standard of Care Battery –Actual touching of person without consent Defamation of character –Injury to another by written or spoken words

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Standard of Care Invasion of privacy –Patient records or any unwanted publicity and exposure given to the public Fraud –Deliberate deception practiced to secure unfair/unlawful gain

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Standard of Care Good Samaritan law –Protection for those individuals not seeking payment but rendering medical assistance to injured Emergencies –Protects care given without intent to do bodily harm

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Standard of Care Americans with Disabilities Act of 1990 Four areas: –Employment discrimination due to disabilities –Disabled provided access to public services –Accommodations and access to goods/services –Telecommunication services

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check A dental assistant is having coffee with friends and begins to discuss the procedures someone they know came into the office to have done. What standard of care has this DA violated? –Invasion of privacy

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Records Informed consent Implied consent (many possibilities): –Patient opening his or her mouth implies for dentist to begin treatment

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Records Subpoenas –Dental records can be subpoenaed –Confidentiality must be kept Statute of limitations –Defines period of time in which legal action can take place

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethics Determination by group of what is right and wrong –Advertising –Professional fees

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethics Professional responsibilities and rights –Dentists cannot refuse service based on race, color, religion, national origin, or sexual orientation –Dentists cannot refuse service because patient has human immunodeficiency virus –Dentists cannot be influenced by personal gain

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. HIPAA Health Insurance Portability and Accountability Act of 1996 –Established safeguards for health care transactions transmitted electronically –National standards –ADA named consultant to Secretary of Department of Health and Human Services (HHS)

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. HIPAA Privacy officer –Reviews HIPAA updates routinely –Checks with ADA repeatedly to ensure compliance –Educates and trains staff –Evaluates areas of concern Creates plan to follow up and monitor compliance

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Transactions and Code Sets Current Dental Terminology (CDT) 2011 –Standard code for vendors, payers, providers, clearinghouses, and government –Revised every two years –Twelve categories –Physicians submit claim in standard format –Practices with fewer than 10 employees exempt

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. HIPAA Compliance –Direct providers (covered entity) Hospitals, clinics, nursing homes, assisted living facilities, home health agencies, physicians, dentists, and alternative medicines –Indirect providers (business associates) Laboratories, pharmacies, surgical centers, and any others dealing with patient information

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. HIPAA Business associates –Any contracted associate of office that may have access to patient information –Business associates of covered entities must comply with HIPAA

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Protected Health Information (PHI) Encompasses any information that can identify an individual Privacy must be maintained

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. PHI Protection of all patient records –Doors locked –Records filed –Day sheets, charts, and schedules out of sight –Fax machines out of sight

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. PHI Rights of individuals: –May access, inspect, and obtain copies of records –May request amendments or corrections

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. PHI Privacy policies and procedure statements –Must be provided to patients –HIPAA Privacy Kit provided by ADA

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. PHI Permitted use and disclosure –Treatment and care coordination –Payment, sharing with family and friends identified by patient, and public health offices

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. PHI Patient health information use and disclosure –Written explanation of all instances of use and disclosure of patient information other than treatment, payment, or health operations

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Consent Requirements Plain language Information practices Right to review before signing Notice may change Right to restrict use and disclosure May revoke consent Signed and dated

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Security Rule Controls access and protects information from accidental or intentional disclosure to unauthorized individuals Prevents alteration, destruction, or loss

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Staff Manual Office HIPAA manual –Privacy Officer and contact person to receive complaints –Job descriptions for each employee –HIPAA training plan Including dates of completion –Business associate audit and forms –Privacy policy statement

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Staff Manual Office HIPAA manual –HIPAA forms and supporting documentation –Documentation of HIPAA compliance and ongoing evaluation –Violation reporting –Confidentiality agreements

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Enforcement of HIPAA Any person or employee may file complaint with HHS Complaints covered under whistleblower provision –No retaliation –Dental offices must self-monitor

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Enforcement of HIPAA Federal civil and criminal penalties for violations of patient’s right to privacy –For disclosures made in error: $100 per violation up to $25,000 per year –For knowingly violating privacy: Up to $50,000 and one-year prison sentence

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Enforcement of HIPAA Federal civil and criminal penalties for violations of patient’s right to privacy –For disclosing information under false pretenses: Up to $100,000 and up to five-year prison sentence

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Enforcement of HIPAA Federal civil and criminal penalties for violations of patient’s right to privacy –For intention to sell, transfer, or use information for commercial gain or intent to maliciously harm: Up to $250,000 and 10-year prison sentence

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Can a health care provider go to jail for violating HIPAA regulations? –Yes, if the violation is intentional

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. ADAA Principles of Ethics and Conduct Maintenance and enrichment of profession Uphold law Upgrade skills