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
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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
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Standard of Care• Tort
– Wrongful act that results in injury to one person by another
• Assault – Threat of touching a person without
consent
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Standard of Care• Battery
– Actual touching of a person without consent
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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
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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
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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
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Dental Records
• Informed consent • Implied consent (many possibilities):
– A patient opening his or her mouth is implying for the dentist to begin treatment
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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
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Ethics
• The determination by a group of what is right and wrong – Advertising– Professional fees
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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
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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
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HIPAA• Complying with HIPAA
– Direct providers (covered entity)• Hospitals, clinics, nursing homes, assisted
living facilities, home health agencies, physicians, dentists, and alternative medicines
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HIPAA• Complying with HIPAA
– Indirect providers (business associates)• Laboratories, pharmacies, surgical centers, and
any others dealing with patient information
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HIPAA• Business Associates
– Any contracted associate of office that may have access to patient information
– Business associates of covered entities must comply with HIPAA
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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
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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
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Protected Health Information (PHI)
• Encompasses any information that can identify an individual
• Privacy must be maintained
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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
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Protect Health Information (PHI)• Rights of the individuals
– Individuals may access, inspect, and obtain copies of records
– May request amendments or corrections
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Protect Health Information (PHI)• Privacy policies and procedure
statements– Must be provided to patients– HIPAA privacy kit provided by ADA
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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
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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
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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
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Security Rule• Ability to control access and protect
information from accidental or intentional disclosure to unauthorized individuals
• Prevents alteration, destruction, or loss
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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
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Staff Manual• Office HIPAA manual
– HIPAA forms and supporting documentation
– Documentation of HIPAA compliance and ongoing evaluation
– Violation reporting– Confidentiality agreements
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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
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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