Compliance, Ethics, & Legal Considerations Flashcards

A HIPAA Security Rule breach involving unsecured PHI affecting 600 patients requires notification to which entities?

Answer: Affected individuals, the Secretary of HHS, and prominent local media outlets

Breaches affecting 500 or more individuals in a state or jurisdiction require notification to affected individuals, HHS, and prominent media outlets in that state or jurisdiction.

Under the ethical principle of 'veracity,' a dentist is obligated to:

Answer: Provide truthful information to patients about their diagnosis and treatment options

Veracity requires dental professionals to be truthful and honest in all communications with patients, including disclosing diagnoses and treatment options accurately.

A dental coder is uncertain whether a procedure qualifies for a particular CDT code. The BEST resource to consult for a definitive coding determination is:

Answer: The CDT codebook's nomenclature and descriptor for the code in question

The ADA CDT codebook contains official nomenclature and descriptors that define the correct application of each code and is the authoritative coding reference.

Which scenario represents a violation of the ADA's ethical principle of 'justice'?

Answer: A dentist refuses to treat a patient solely because the patient is HIV-positive

Justice requires fair and equal treatment; refusing care solely on the basis of a patient's HIV status is discriminatory and violates professional and legal standards, including the Americans with Disabilities Act.

A dental office must retain patient records for a minimum period set by state law. If state law is silent on the issue, HIPAA requires covered entities to retain documentation of their privacy policies for:

Answer: 6 years from the date of creation or last effective date, whichever is later

HIPAA requires covered entities to retain required documentation, including policies and procedures, for six years from the date of creation or the last effective date, whichever is later.

A dentist participates in a fee-splitting arrangement where they pay a marketing company a percentage of revenue for each new patient referred. This is MOST likely a violation of:

Answer: Anti-Kickback Statute

Paying a percentage of revenue for patient referrals is a classic kickback arrangement prohibited by the Anti-Kickback Statute because it can corrupt clinical decision-making.

When a dental practice discovers a coding error that resulted in overpayment from a federal payer, the compliance best practice is to:

Answer: Refund the overpayment promptly and document the corrective action taken

Prompt self-disclosure and repayment of identified overpayments is required by the False Claims Act's 60-day rule and demonstrates good-faith compliance efforts.