3 Jurisprudence, and the Health Information Portability and Accountability Act

2 The Law Set of rules established and enforced by government –Local, state, and federal Criminal and Civil Law –Charges brought against a dentist involve civil law –Criminal law involves wrongs committed against society

3 The Law Dental Practice Act –Dental team members’ duties and functions as licensed or nonlicensed –States what duties are allowed Includes expanded functions –State guidelines are determined by each state Identifies grounds for suspension

4 The Law State Board of Dentistry –Responsible for enforcing Dental Practice Act for its state –License to practice is granted when: Dentist has met minimum educational and moral requirements Passed written and clinical examinations

5 The Law State Board of Dentistry –Expanded functions –Certification, licensure, and registration Some states require that dental assistants are certified, licensed, or registered Continuing education is necessary to retain registration or license

6 The Dentist, Dental Assistant, and the Law Contracts –Expressed versus implied contracts –Termination

7 The Dentist, Dental Assistant, and the Law –Dental assistants are agents of the dentist –Dentist is ultimately responsible for actions of dental assistant and liable for their actions and comments Res gestae refers to “part of the action” Admissible in a court of law

8 Standard of Care Malpractice –Four Ds of malpractice are: Duty Derelict Direct cause Damage

9 Standard of Care Tort –Wrongful act that results in injury to one person by another Assault –Threat of touching a person without consent

10 Standard of Care Battery –Actual touching of a person without consent

11 Standard of Care Defamation of character –Injury to another by written or spoken words Invasion of privacy –Patient records or any unwanted publicity and exposure is given to the public

12 Standard of Care Fraud –Deliberate deception that is practiced to secure unfair/unlawful gain

13 Standard of Care Good Samaritan Law –Protection for those individuals who are not seeking payment but are rendering medical assistance to the injured (emergencies) –Care given without intent to do bodily harm is protected under Good Samaritan

14 Standard of Care Americans with Disabilities Act of 1990 Four areas –Employment discrimination due to disabilities –Disabled are provided access to public services –Accommodations and access to goods/services –Telecommunication services

15 Dental Records Informed consent Implied consent (many possibilities): –A patient opening his or her mouth is implying for the dentist to begin treatment

16 Dental Records Subpoenas –Dental records can also be subpoenaed –Confidentiality must be kept Statute of limitations –Defines the period of time in which legal action can take place

17 Ethics The determination by a group of what is right and wrong –Advertising –Professional fees

18 Ethics Professional responsibilities and rights –Dentists cannot refuse service based on race, color, religion, national origin, or sexual orientation –Dentists cannot refuse service because the patient has human immunodeficiency virus –Dentists cannot be influenced by personal gain

19 HIPAA Health Insurance Portability and Accountability Act of 1996 –Established safeguards for health care transactions transmitted electronically –National standards –American Dental Association (ADA) named consultant to Secretary of HHS

20 HIPAA Complying with HIPAA –Direct providers (covered entity) Hospitals, clinics, nursing homes, assisted living facilities, home health agencies, physicians, dentists, and alternative medicines

21 HIPAA Complying with HIPAA –Indirect providers (business associates) Laboratories, pharmacies, surgical centers, and any others dealing with patient information

22 HIPAA Business Associates –Any contracted associate of office that may have access to patient information –Business associates of covered entities must comply with HIPAA

23 HIPAA Privacy Officer –Reviews HIPAA updates routinely –Checks with ADA repeatedly to ensure compliance –Educates and trains staff –Evaluates areas of concern and creates plan to follow up and monitor compliance

24 Transactions and Code Sets Current Dental Terminology (CDT) 2005 –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 are exempt

25 Protected Health Information (PHI) Encompasses any information that can identify an individual Privacy must be maintained

26 Protect Health Information (PHI) Protection of all patient records –Lock doors –Records filed –Day sheets, charts, and schedules out of sight –Fax machines out of view

27 Protect Health Information (PHI) Rights of the individuals –Individuals may access, inspect, and obtain copies of records –May request amendments or corrections

28 Protect Health Information (PHI) Privacy policies and procedure statements –Must be provided to patients –HIPAA privacy kit provided by ADA

29 Protect Health Information (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

30 Protect Health Information (PHI) Permitted use and disclosure –Treatment and care coordination –Payment, sharing with family and friends identified by patient, and public health offices

31 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

32 Security Rule Ability to control access and protect information from accidental or intentional disclosure to unauthorized individuals Prevents alteration, destruction, or loss

33 Staff Manual Office HIPAA manual –Identifies PO and contact person to receive complaints –Job descriptions for each employee –HIPAA training plan, dates of completion –Business associate audit and forms –Privacy policy statement

34 Staff Manual Office HIPAA manual –HIPAA forms and supporting documentation –Documentation of HIPAA compliance and ongoing evaluation –Violation reporting –Confidentiality agreements

35 Enforcement of HIPAA Any person or employee may file a complaint with the Department of Health and Human Services Complaints covered under the whistleblower provision –No retaliation –Dental offices must self-monitor

36 Enforcement of HIPAA Federal civil and criminal penalties for violations of patient’s right to privacy –$100 per violation, up to $25,000 per year for disclosures made in error –Up to $50,000 and one-year prison sentence for knowingly violating privacy

37 Enforcement of HIPAA Federal civil and criminal penalties for violations of patient’s right to privacy –Up to $100,000 and up to 5 years prison sentence for disclosing information under false pretences

38 Enforcement of HIPAA Federal civil and criminal penalties for violations of patient’s right to privacy –Up to $250,000 and 10 years imprisonment for intention to sell, transfer, or use information for commercial gain or intent to maliciously harm