CDC Ethics & Professional Standards 2 — Questions and Answers
Question 1: A dental consultant discovers that a claim was paid in error due to a coding mistake made by the insurance company. What is the ethical obligation?
- Ignore it since the error was not the dentist's fault
- Report the overpayment and arrange for recovery (Correct answer)
- Apply the overpayment to future claims silently
- Notify only if the amount exceeds $500
Correct answer: Report the overpayment and arrange for recovery
Ethical standards require transparency; overpayments must be reported and returned regardless of who caused the error.
Question 2: Which principle of dental ethics requires that practitioners treat patients with equal fairness regardless of their insurance status?
- Nonmaleficence
- Autonomy
- Justice (Correct answer)
- Veracity
Correct answer: Justice
Justice demands equitable treatment and fair distribution of dental services without discrimination based on payment source.
Question 3: A dental consultant is asked to review a claim from a personal friend's dental office. What is the most appropriate course of action?
- Review the claim with extra scrutiny to appear impartial
- Recuse themselves and assign the claim to another reviewer (Correct answer)
- Approve the claim as a professional courtesy
- Deny the claim to avoid any appearance of favoritism
Correct answer: Recuse themselves and assign the claim to another reviewer
Conflicts of interest must be avoided by recusing oneself from reviewing claims involving personal relationships.
Question 4: Under HIPAA, which of the following is an example of a permissible disclosure of protected health information (PHI) without patient authorization?
- Sharing PHI with a marketing firm for advertising purposes
- Disclosing PHI to a dental insurer for claims processing (Correct answer)
- Releasing PHI to an employer for workplace monitoring
- Selling PHI to a research company for profit
Correct answer: Disclosing PHI to a dental insurer for claims processing
HIPAA permits disclosure of PHI for treatment, payment, and healthcare operations, including insurance claims processing.
Question 5: A dental consultant suspects that a dentist is submitting inflated procedure codes to maximize reimbursement. This practice is best defined as:
- Upcoding (Correct answer)
- Downcoding
- Bundling
- Unbundling
Correct answer: Upcoding
Upcoding is the fraudulent practice of billing for a more expensive procedure than was actually performed.
Question 6: Which ADA Principle of Ethics addresses the dentist's duty to keep professional knowledge and skills current?
- Patient Autonomy
- Nonmaleficence
- Beneficence (Correct answer)
- Veracity
Correct answer: Beneficence
Beneficence encompasses the duty to act in the patient's best interest, which includes maintaining competence through continuing education.
Question 7: A dental consultant receives a gift from a dental practice whose claims they regularly review. According to professional ethics, the consultant should:
- Accept it as a token of professional courtesy
- Decline the gift to preserve objectivity and avoid conflicts of interest (Correct answer)
- Accept it but disclose it to their supervisor
- Accept gifts under $50 as a common professional norm
Correct answer: Decline the gift to preserve objectivity and avoid conflicts of interest
Accepting gifts from parties whose claims you review compromises impartiality and violates conflict-of-interest standards.
CDC Ethics & Professional Standards 2
A dental consultant discovers that a claim was paid in error due to a coding mistake made by the insurance company.
What is the ethical obligation?