CDC Ethics & Professional Standards 3 — Questions and Answers
Question 1: A patient requests that their dental records not be shared with their insurance company. How should a dental professional respond?
- Share the records anyway since insurers have automatic access rights
- Honor the request, but advise the patient that claims may be denied without records (Correct answer)
- Refuse to treat the patient if they withhold consent
- Report the patient's request to the state dental board
Correct answer: Honor the request, but advise the patient that claims may be denied without records
Patients have the right to restrict disclosures, but must be informed that doing so may affect insurance payment for services.
Question 2: Which of the following scenarios represents a violation of the ethical standard of veracity in dental consulting?
- Denying a claim that lacks supporting documentation
- Approving a claim that appears inconsistent with clinical norms without investigation (Correct answer)
- Requesting additional records before making a determination
- Consulting a clinical specialist about a complex procedure claim
Correct answer: Approving a claim that appears inconsistent with clinical norms without investigation
Approving a questionable claim without investigation is dishonest and violates the commitment to truthful, evidence-based decisions.
Question 3: When a dental consultant's determination conflicts with the treating dentist's clinical judgment, the best ethical approach is to:
- Always defer to the treating dentist to avoid conflict
- Automatically override the dentist's judgment based on plan terms
- Consider the clinical rationale provided while applying plan benefits fairly (Correct answer)
- Refer all such cases to litigation
Correct answer: Consider the clinical rationale provided while applying plan benefits fairly
Ethical consultants weigh clinical documentation thoughtfully while applying plan provisions — neither blanket deference nor automatic overrides are appropriate.
Question 4: The NADP Code of Professional Conduct primarily governs which group?
- Dental hygienists
- Dental benefit plan professionals (Correct answer)
- State dental board members
- Oral surgery specialists
Correct answer: Dental benefit plan professionals
The NADP (National Association of Dental Plans) Code guides ethical conduct for professionals working in the dental benefits industry.
Question 5: A dental plan's internal policy conflicts with a state law regarding coverage of a specific procedure. Which takes precedence?
- The dental plan's internal policy always governs
- The state law takes precedence over the plan policy (Correct answer)
- The federal dental standard overrides both
- The treating dentist's preference governs
Correct answer: The state law takes precedence over the plan policy
State laws set minimum legal requirements that dental plans must follow; internal policies cannot override applicable law.
Question 6: Which of the following best describes the ethical duty of 'nonmaleficence' as applied in dental consulting?
- Ensuring patients receive the most expensive treatment available
- Avoiding decisions that result in unnecessary harm to patients or providers (Correct answer)
- Maximizing profits for the insurance company
- Treating all claims identically regardless of clinical context
Correct answer: Avoiding decisions that result in unnecessary harm to patients or providers
Nonmaleficence means 'do no harm' — consultants must avoid decisions that unjustly harm patients, providers, or plan integrity.
Question 7: A dental consultant learns that a colleague is approving claims for procedures that were never performed. The ethical obligation is to:
- Ignore it to maintain workplace harmony
- Confront the colleague privately and take no further action
- Report the suspected fraud to the appropriate authority (Correct answer)
- Approve similar claims to maintain consistency
Correct answer: Report the suspected fraud to the appropriate authority
Reporting suspected fraud to the appropriate authority (compliance officer, state board, or fraud hotline) is an ethical and often legal obligation.
CDC Ethics & Professional Standards 3
A patient requests that their dental records not be shared with their insurance company.
How should a dental professional respond?