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