Transcript CD 838 “Justice and the Profession”

CDS 238
“Ethical Situations and
the Law”
February 14, 2011
Sharon P. Turner, DDS, JD
Today’s Topics
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Fraud in dental
practice
Patient abandonment
in dental practice
Healthcare Integrity
and Protection Data
Base (HIPDB)
National Practitioner
Data Base (NPDB)
Learning Goals
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Know the elements of fraud so
as to recognize actions that
are considered fraud in dental
practice
Know the elements of patient
abandonment so as to
recognize actions that are
considered abandonment of a
patient in dental practice
Know what the HIPDB is and
how a dentist gets entered into
this data bank
Know what the NPDB is and
how a dentist gets entered into
this data bank
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Integration of today’s topics into
CDS
838
Justice from a legal perspective
means the proper administration
of laws, similar wrong behavior
gets similar punishment, fair
handling
Justice from a bioethical
perspective instructs that benefits
and burdens ought to be
distributed equitably, scarce
resources allocated fairly, one
should act such that no one
person or group bears a
disproportionate share of
burdens (distributive justice) or
gains a disproportionate share of
benefits
Justice in general is associated
with moral rightness or goodness
in human actions
Guiding Thoughts
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Keeping the best interest of your patient
always in mind will serve you well
Always ask yourself if this treatment is
what you would want for yourself or your
family
There is honor in admitting that your
outcome is not as desired and you want to
correct the situation
Ignorance of the law is NO excuse!
General Areas of the Law
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Criminal: Generally codified common law, but if
there are gaps in statutes, go back to common
law for meaning. Guilty (convicted) or innocent
(acquitted). Fines or imprisonment, even loss of
life.
Civil: Some is codified, but much is derived
from the publication of similar cases heard in
appellate courts. Liability or no liability.
Administrative: Often takes the form of
regulations. Completely statutory. Overseen by
agencies such at the KBD
Two Types of Torts
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Negligence
Mistake
Failure to meet the
standard of care which is
the duty that all health
care providers have to
their patients
Malpractice= Bad practice
Elements=Duty, Breach,
Causation, Damages
Expert establishes
standard of care
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Intentional
Action taken purposefully
Intent may be inferred if
a person is “willfully
ignorant”
Battery, Fraud,
Abandonment,
Defamation
Patient Abandonment
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The intentional, unilateral, nonconsensual
termination of a dentist/ patient
relationship before completion of services
agreed to or necessary follow up has been
performed
Is intentional form of malpractice
Elements of Abandonment
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Intentional or
foreseeable from
decisions made
Unilateral
Nonconsensual
Termination of
relationship
Prior to completion of
treatment agreed to or
follow up required after
treatment
Resulting in harm to the
patient
Negligent Discharge
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Different from abandonment in that the
decision to terminate care is based on
failure to use due care in deciding that
treatment or follow up is no longer
needed by the patient
Is negligent form of malpractice
So what is the difference?
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You may still get sued in civil court
You may still get disciplined by the Board of
Dentistry in an administrative proceeding
Unlike in a negligence action where an expert
witness is mandatory to establish breach of the
standard of care, no expert witness is needed to
prove abandonment
Your malpractice insurance may not, probably
will not, cover an intentional form of malpractice
if you lose in litigation!
DUTIES
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PATIENT
Cooperation
Keep appointments
Follow advice
Take medication
Pay for services
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DENTIST
Complete treatment
In timely fashion
Acceptable quality
Follow up afterwards
as needed
Refer to a specialist
for treatment beyond
the scope/skill
Maintain current skill
and knowledge
Examples of Abandonment from
Actual Litigation
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Unqualified refusal to further attend to patient
Express declaration or statement of withdrawal
Leaving patient during or immediately after an operation
or procedure
Failure to attend to a patient despite a promise to do so
Unexplained failure to continue attending to patient
Refusal to treat a patient at a specific time or place
Undertaking care that is beyond skill level and not
rapidly placing the patient in the hands of a specialist
Dicke v. Graves
668 P.2d 189 (Kan.App. 1983)
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Facts:
Mrs. Graves was a patient of Dr. Dicke from 1974 until
1979. She had a difficult dental history, with complex
and continuing problems. She had experienced complete
restoration of all of her teeth which was complicated by
TMJ disorders, jaw thrust, and sensitivity to electrolytic
interactions. In 1979 she reported and Dr. Dicke
confirmed fractures in her porcelain bridgework. X-rays
were made and no other problems were disclosed.
Two weeks later she complained of a toothache and
Dr. Dicke noted movement of the bridgework and
concluded there were stress fractures in bridge and that
she would required a repeat complete restoration of her
teeth.
Dicke v. Graves
Continued
Six weeks later impressions were taken to determine a
recommended compete restorative treatment approach.
Mrs. Graves continued to have discomfort. She and
her husband made multiple telephone calls and hand
delivered a letter seeking rapid commencement of
treatment as she was in continuous discomfort. Dr.
Dicke did not respond.
One month after hand delivering the letter to Dr.
Dicke, Mrs. Graves sought treatment with another
dentist who made the same diagnosis as Dr. Dicke and
immediately began the comprehensive treatment which
was completed in December.
Dicke v. Graves
Continued
There was no complaint that any diagnoses
were flawed or that any of the treatment that
Dr. Dicke provided was deficient. (No alleged
breach of the standard of care for diagnosis or
treatment.)
Dr. Dicke sued Mrs. Graves (presumably for
nonpayment of services) and she
counterclaimed for patient abandonment.
At the trial court level, the jury entered a
judgment against Dr. Dicke and he appealed.
Dicke v. Graves
Continued
The issue which the appeals court addressed
was: Did Dr. Dicke withdraw from the patient
dentist relationship?
The court determined that Dr. Dicke was nondiligent in his care, that is untimely, delayed,
inattentive all of which were if anything
negligent BUT NOT ABANDONMENT. Therefore
the trial court judgment was reversed.
Lessons from Dicke v. Graves
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Dr. Dicke was lucky that Mrs. Graves’ lawyer brought
suit under the wrong cause of action and did not prove
abandonment when negligence might well have been
provable. You won’t always be lucky!
Dr. Dicke probably got into this because he sued Mrs.
Graves for nonpayment. If you are going to sue for
nonpayment, be sure that you have “clean hands”
yourself.
Legal cases are very fact specific. The jury or judge must
take the unique facts in any case and apply the
appropriate law. A small change in facts can render a
very different outcome.
Lessons from Dicke v. Graves
Continued
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Respond to your patients in a timely manner
If you do not wish to continue care or feel that
the situation is beyond your skill level, find
another provider or a specialist to whom you can
refer the patient in a timely manner
Never leave town without having someone
available to take call for you who has agreed to
take call and having your office answering
machine or answering service clearly instruct
patients what steps to take should they need
dental services in your absence
How do I protect myself from
liability for patient abandonment?
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Review “patient duties”
If a patient is not living up to the patient duties
and you ARE living up to yours, consider
termination of the patient/dentist relationship
Terminate the relationship by letter, sent by
certified mail, return receipt requested. State the
reason for the termination of the relationship.
The reason cannot be a pretense intended to
cover a discriminatory reason for termination of
the relationship, e.g., HIV status
Protections from Abandonment
Actions con’t
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Provide a 30 day period (or whatever is
reasonable for the situation, not less than 30
days) during which you will be available to
provide emergency treatment.
Do not terminate care while a procedure is
ongoing, even if you do not think that you will
get paid. Finish the procedure and the required
follow up first, then dismiss the patient. Special
considerations for orthodontic cases!
What about “dentist
abandonment?”
If a patient is overdue for recall,
has failed to come back to get
definitive crown placed, write the
patient a letter and place a copy
in the chart
Fraud in Dental Practice
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An intentional perversion of the truth for
the purpose of inducing another in
reliance upon it to part with some valuable
thing belonging to him or to surrender a
legal right.
The false representation of a matter of
fact by words or conduct, false or
misleading allegations or concealment of
that which should have been disclosed.
Elements of Fraud
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Representation of something as fact or omission thereof
That is material (essential) to decision-making or action
That is false
That the presenter knows it is false
That the presenter intends it to be acted upon
That the person to whom the fact is represented does
not know is false
That the person to whom the fact is represented relies
upon in taking action
That the person has a right to rely upon the
representation due to relationship
That the actor suffers damage of a consequence of
reliance and action upon the false information
Examples of Fraud in Dental
Practice
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Telling an untruth to induce a patient to have a
treatment
“Up coding” a procedure, i.e. MO becomes MOD
or all extractions are “surgical extractions”
Billing for procedures never performed
Billing for services not yet completed even upon
patient request
Overbilling/double billing (see Nov. 2004 AGD
Impact, p. 14, “Top clinician questions esthetic
dentistry over treatment”
Dr. Gordon Christensen
Waiver of an insurance co-payment or
deductible
Examples of Fraud in Dental
Practice (con’t)
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Charging different fees (higher) to insured
patients than to self pay patients systematically
Alternation and/or destruction of records
Making false entries into records
Providing false or purposely incomplete
information to a licensure board, credentialing
office or third party payer
Billing for work done by someone else, i.e.
attending billing for work done by resident when
attending is not present for “critical parts of the
procedure”
Miller v. Commonwealth of
Pennsylvania, State Dental Council
(Pa.Cmwlth, 396 A. 2d 83, 1979)
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Facts:
Dr. Miller owned a sole proprietorship dental practice
specializing in oral and maxillofacial surgery. He had
three other oral surgeons working in his clinic,
presumably as independent contractors rather than
employees. An investigation and review conducted by
representatives of Pennsylvania Blue Shield of those
persons or institutions receiving more than $10,000 in
payment for oral surgery services for any specific year
revealed numerous discrepancies at the Miller Clinic.
Miller v. Commonwealth
Continued
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The insurance company reported these
discrepancies to the Council, which issued
citations charging the 4 surgeons with
filing false claims in violation of the law
prohibiting fraudulent or unlawful
practices or fraudulent misleading or
deceptive representations and
unprofessional conduct detrimental to the
public health, safety, morals or welfare.
Miller v. Commonwealth
Continued
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The surgeons were sited for submitting claims to
Blue Shield for the removal of impacted teeth,
when, in fact, the Council found that the x-rays
and other documents available to them indicated
that the teeth extracted were NOT impacted.
More than 100 such discrepancies were
documented.
Blue Shield coverage excluded coverage for oral
surgical services related to the extraction of
teeth other than fully or partially impacted teeth.
Miller v. Commonwealth
Continued
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Each of the surgeons had executed an authorization
agreement accepting full responsibility for all statements,
representations, and certifications appearing on all
claims submitted to Pennsylvania Blue Shield
The surgeon who preformed the treatment was
responsible for listing the exact operative procedure on
the patient’s chart.
After 4 days of extensive hearings, the Council ordered
suspension of the licenses to practice of all 4 surgeons
for 3 months for the nonowners and 6 months for the
clinic owner for fraudulent and unlawful practices.
The 4 surgeons appealed the suspensions of their
licenses. The owner’s appeal was handled separately
from that of the 3 other surgeons.
Miller v. Commonwealth
Continued
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On appeal the surgeons argued that it wasn’t their fault,
it was the clerks who processed the claim forms! The
court responded that this “argument seems almost
ludicrous in view of the fact that they assumed full
responsibility for all information submitted over their
signature stamps.”
They also argued that they shouldn’t be charged with
“knowing the claims were false.” The court found that
the practice at the clinic indicated at the very least a
“reckless ignorance” and in fact the evidence did indicate
that they had actual knowledge of the falsity of the
claims.
Miller v. Commonwealth
Continued
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They also argued that they didn’t mean to
defraud to which the court responded, “Where
the necessary consequence of an act is to
defraud, it is no defense that the actor had no
intention to cheat or defraud.”
They also argued that the Council had no
jurisdiction of this matter since it did not involve
a dentist/patient relationship and the insurance
company had other remedies available to it to
which, in a beautiful description of the Council’s
responsibility to protect the public, the court
responded:
Miller v. Commonwealth
Continued
“…we are not here dealing with a civil suit to
enforce individual rights. Rather, we are
dealing with an administrative agency of
the sovereign which seeks to carry out its
duty to protect the citizens of the
Commonwealth by regulating the conduct
of its licensees. It is the interests of many
rather than the interests of the few which
impels the Board.”
Miller v. Commonwealth
Continued
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The court upheld the suspensions of licenses of
the 3 nonowners but reversed the suspension of
Dr. Miller’s license because it found that there
was insufficient evidence to show that he knew
of the fraudulent claims and none of the claims
in question had been signed via Dr. Miller’s
signature stamp. Further, because the other
surgeons were independent contractors and not
employees, he could not be held responsible for
their actions under the legal doctrine of
respondeat superior, which would otherwise
make the master (employer) responsible for the
wrongdoings of his servants.
Lessons from
Miller v. Commonwealth
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Don’t “up code”- it is fraud
It doesn’t matter if the patients want you to or that they
get benefit from what you do
Don’t try and blame the hired help- you are ultimately
responsible, especially where you sign a contract so
stating
You must abide by all the terms of contracts that you
sign with insurance companies- know what is in those
contracts!
Courts are very deferential to administrative agencies
such as Boards of Dentistry provided that they have
followed their own procedures. For example, Rules of
Evidence are relaxed in terms of what is admissible and
what is not in agency hearings.
Lessons from
Miller v. Commonwealth (con’t)
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Insurance companies may elect from among
multiple possible remedies including filing
complaints with the licensing board
(administrative law), civil suits for refund of
money obtained under false pretense (civil law),
or, if the magnitude is sufficient, pursing
criminal charges for fraud (criminal law) as a
punishment and to put the dentist out of
business!
Penalties for fraud can be suspension or loss of
license, fines, imprisonment
Caudill vs. Kentucky Board
of Dentistry
2006 WL357879 (Ky. App.)
Dentist entered an Alford plea and was
convicted of Medicaid Fraud
KBD placed his license on probationary
status until he paid the restitution
ordered by the court
Caudill vs. KBD
2006
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Court held that: 1) the crime was one of
moral turpitude 2) KDB has discretionary
authority to discipline for this; 3) Alford
conviction is a conviction and 4) It doesn’t
matter if D didn’t know the plea would
subject him to KDB disciplinary action
Adames vs. Velasquez
NY (2008)
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D were a laboratory technician working in his
wife’s dental practice and his wife, the dentist
P alleges that D offered to provide
discounted dental services if P came to the
office at night and paid in cash
P alleges that he was never told that D was
not a dentist
Restorative TX done by husband was
substandard, caused pain and subsequent
tooth loss
Adames vs. Velasquez
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D motion to dismiss denied
Fraud may be committed by a failure to
speak
Wife is potentially liable under respondeat
superior
Receipt of payment not necessary for
fraud
Adames vs. Velasquez
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Cited a KDB case, unlicensed and well
intentioned charitable dentist trained
religious missionaries in “practical
dentistry”- KBD barred the action, the
court upheld saying. “Nor can we accept
the appellant’s proposition that the
statutes are only aimed at masqueraders
and quacks who prey upon the public for
compensation.” (Lewis v. Kentucky State
Dental Examiners, 300 S.W.2d 241, 1957)
Adames vs. Velasquez
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Employer dentists must ensure that
employees are properly licensed
How bad can it get?
Office of the Attorney General
State of California
Department of Justice
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September 22, 2004
Attorney General Bill Lockyer files criminal
charges; This will become: State v. Teo
Central Valley Dentist and 19 others charged
with defrauding the state Medi-Cal System of
$4.5 million by performing unnecessary dental
work on unsuspecting patients
State v. Teo
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Defendant placed adds on missing
children flyers and offered gifts or rebates
to Medi-Cal beneficiaries who sought
services through clinical network
Also charged with workers’ compensation
fraud, conspiracy, grand theft, child
abuse, elder abuse, assault and intentional
infliction of great bodily injury.
State v. Teo
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Dentists who participated were given kickbacks of 25% which
provided an incentive to over treat
Dental assistants were permitted to perform duties not allowed
under state law
False insurance claims were filed on fabricated charts
AG says “these dentists put at risk the health and well being of
hundreds of children and adults by performing slipshod dental
services that were unnecessary, ignoring health problems that
needed tending and even skimping on appropriate amounts of
anesthesia before submitting patients to painful procedures.”
Children were forcibly restrained.
Investigation was conducted by Bureau of Medi-Cal Fraud and Elder
Abuse and assisted by the Department of Health Services
Dead men do tell tales!
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In 2004, there were
approximately 25 cases of
dental fraud pending as a
result of the forensic
identification of the
remains of those who
were killed in the World
Trade Center on
September 11, 2001
This was discovered
when dental records
provided to help identify
remains were examined
in conjunction with
remains.
In the matter of the Bar Admission
of Edward Littlejohn
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261 Wis.2d 183 (2003)
Don’t expect to become a licensed attorney in
another state if you are suspended from the
practice of dentistry for inadequate infection
control, fraud, delivery of unnecessary dental
services and practices beyond the scope of your
dental license!
It didn’t work for Edward Littlejohn who was not
able to satisfy a character and fitness
investigation for the Bar after losing his dental
license in Minnesota.
Healthcare Integrity and Protection
Data Bank (HIPDB)
History:
The Health Insurance Portability and
Accountability Act of 1996 mandated creation of
HIPDB by the Secretary of the Department of
Health and Human Services acting through the
Office of the Inspector General.
The legislation that set up HIPDB is Section
1128E of the Social Security Act
Final regulations governing HIPDB are codified in
the Federal Register at
45 CFR Part 61
Background for HIPDB
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Cases like Miller v. Commonwealth and
State v. Teo REALLY DO occur casting a
pall over all of us in the dental profession
Health care fraud is involved in an
estimated 3 to 10% of all health care
expenditures and cost between $30 and
$100 billion in 1997
Purposes of HIPDB
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To help combat fraud
To improve the quality of health care
Accomplished by maintaining a data base of final
adverse actions taken against health care practitioners,
providers or suppliers
Information from HIPDB should be used in making
decisions regarding affiliation, certification, credentialing,
contracting, hiring and licensure
Prevents persons with bad actions/outcomes from
moving to a new location and beginning practice without
consideration of past acts/outcomes
Intended Use of HIPDB
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A flagging system that serves to alert
users of the need for a more
comprehensive review of a practitioner’s
past actions and professional credentials
Should be used in combination with other
sources in determining whether to
employ, affiliate, certify or license an
individual
What gets reported to the HIPDB?
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Adverse action on practitioner licenses or
certification due to fraud
Denial of application for licensure or license
renewal
Exclusion from participation in Federal and State
health care programs or cancellation of a health
plan contract due to fraudulent or
unprofessional behavior or poor quality of
services
Criminal convictions related to health care
delivery
What gets reported to the HIPDB?
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Civil judgments related to health care
fraud but not malpractice
Injunctions ordered to stop harmful or
unprofessional practice
Nolo contendere (no contest) pleas to
criminal actions involving fraud in health
care practice
Who must report to the HIPDB?
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“Eligible entities” defined as:
Federal of State Government Agencies
OR
Health Plans
Who must report to the HIPDB?
Federal or State Government Agencies
US Dept. of Justice, e.g. FBI, US Attorneys, DEA
US Dept. of Health and Human Services, e.g. FDA,
CMS, OIG
Federal agencies that administer or pay for health
care, e.g. Depts. of Defense and V.A.
Federal and State law enforcement, e.g. county and
district attorneys and county police departments
State Medicaid Fraud Control Units
Federal or state agencies responsible for licensing or
certifying practitioners
Who must report to HIPDB?
Health Plans
Health insurance policies
Contract for service benefit organizations
Membership agreement with an HMO
An insurance company
Medicare
Medicaid
Department of Defense
Department of Veterans Affairs
Bureau of Indian Affairs
Who must report to HIPDB?
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For you, the important thing to remember
is that you as an individual practitioner are
not required to report- if you are involved
in a situation that requires reporting, the
Board of Dentistry or other government
agency or the insurance plan will be the
entity required to report.
When does a report have to be
made to HIPDB?
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Within 30 calendar days of the date that the adverse
action was taken
Once submitted, a notice of receipt of report is mailed to
the reporting entity and to the subject of the report, so
you should know if your name has been entered into the
HIPDB. Subjects are also given an opportunity to dispute
the factual accuracy of the report or the reporting
entity’s eligibility to report, but only reporting entities
can change reports. Subjects can add a statement to the
report of no more than 2,000 characters. There is no
time frame that limits when a dispute must be resolved
and a dispute may be submitted at any time, not just
upon initial notification.
When does a report have to be
made to the HIPDB? Con’t
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Report subjects may file a Notice of
Appeal when there is an appeal of the
adverse action pending
Can I find out if I have a file in the
HIPDB?
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Yes, you can query the HIPDB to see if there is
any information about you there. There is a fee
to do so.
Some insurance plans and state licensing boards
may require that you query and provide a copy
of the result to them before participation in the
plan or issuance of a license. There is no law
mandating that you do so, but you will not get
to participate in the plan or get a license if you
do not!
Does the law require mandatory
query by eligible entities?
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No and this is different from the National
Practitioner Data Base- this is why you
may be required to provide a copy of a
self query because then you pay for the
query!
Requirement of Confidentiality
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Reports made to HIPDB are confidential
and those assessing them have a duty to
protect the confidentiality of the reports
Patient names are not kept in the report
of adverse actions
HIPDB cannot be accessed by the public
Is there liability for those who report
practitioners to HIPDB?
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No, there is specific protection against
liability for mandatory reporting UNLESS
the report is knowingly false/malicious
National Practitioner Data Bank
(NPDB)
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History:
Established through Title IV of Public Law
99-660 in the Health Care Quality
Improvement Act of 1986
Purpose of NPDB
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A flagging system to facilitate a comprehensive review of
health care practitioners’ professional credentials
Acts as a clearing house of information relating to
medical malpractice payments, adverse actions taken
against the licenses, clinical privileges, professional
society memberships of dentists, physicians and other
licensed health care practitioners
May inhibit movement from one jurisdiction to another of
a practitioner who has significant malpractice history or
has been deemed unprofessional
What gets reported to the NPDB?
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Medical malpractice payments, either
settlements out of court or court awarded
damages as the result of loss of civil litigation.
(Report within 30 days)
Adverse licensure actions such as fines,
reprimand, probation, suspension, revocation,
non renewal, voluntary surrender while under
investigation, or action taken by the Board of
one state in response to disciplinary action
related to professional competence by another
state. (Report within 30 days)
What gets reported to the NPDB?
Con’t
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Adverse clinical privileges actions that affect
practice privileges for 30 days or more. (Report
within 15 days)
Adverse professional society membership actions
based on professional competence or
professional conduct which affects or could
adversely affect the health or welfare of a
patient. (Report within 15 days)
Exclusion from Medicare and Medicaid programs
Who has to report to the NPDB?
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Insurance companies paying settlements
or judgments
Licensing boards
Hospitals or other health care entities that
grant privileges
Professional societies
Peer review organizations
Private accreditation organizations
State health care entity licensing boards
Penalties for failure to report
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Insurance companies: $11,000 for each
payment not reported
Licensing boards: correct the action or HHS
designates another entity for reporting to NPDB
Hospitals and other entities & Professional
Societies: Publication of noncompliance in
Federal Register and loss of Title IV immunity
for professional review activities for 3 years
Significance of Loss of Title IV
Immunity
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Title IV immunity permits internal peer
review processes to be held private and
not subject to discovery in litigation.
The rationale for this is that the intention
of peer review is to improve the quality of
care at the institution and if this
information were discoverable, it would
not be freely disclosed and the quality of
patient care would suffer.
Who queries the NPBD?
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Licensing boards MAY before issuing new or renewed licenses
Hospitals MUST prior to granting privileges to dentists or
physicians and every two years thereafter
Other health care entities MAY query prior to employing or
signing agreements with providers
Professional societies MAY query prior to granting
membership
An individual provider MAY query at any time, a fee is
required
Quality improvement organizations under contract with CMS
State Medicaid Fraud Control Units
US Comptroller General
US Attorney General & other law enforcement
Researchers for statistical data only
Plaintiff's attorney or pro se plaintiff
Insurance providers MAY NOT query
The public MAY NOT query
Confidentiality and Protection of
Liability for Reporting to NPDB and
Notification if a Report Has Been
Filed
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These are the same as for HIPDB
Other facts of interest about the
NPDB
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Students are not reportable as they are always
functioning under the license of a supervising faculty
who may be reported for actions which occurred during
supervision of a student provider
For the reporting requirement to be triggered for medical
malpractice payments, there has to be a written
complaint demanding money. This can be a formal law
suit or simply a letter. Oral complaints that are resolved
by payment need not be reported.
If the insurance company pays a settlement with which
you disagree, you are still reported to the NPDB. Check
the terms of your malpractice insurance to be certain
that you have the right to the final determination of
settlement if you have that choice.
Other interesting facts about NPDB
Con’t
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Individuals are not required to report on
payments in their own behalf as of 1993, as a
result of a decision of the District of Columbia
Federal Circuit Court of Appeals
If payments are made by a practitioner himself
or herself from personal resources, there is no
reporting requirement.
Only monetary payments need be reported.
Waiver of payment or debt as a settlement
device does not require a report.
There is no lower limit of the payment that
triggers the reporting requirement.
*Refund offered due to
“Money Back Guarantee”*
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Never make money back guarantees! Dentistry
is a professional service, not the sale of goods.
You can stand behind your work without doing
so this explicitly.
When you make a guarantee, you have opened
yourself to liability under contract theories in
addition to traditional tort theories, which is
where malpractice suits are classified
If you do this, you may have to report any
refunds made under this policy to written
complaints if paid by a third party. But third
parties do not cover contract liability generally.
Overlap Between HIPDB and
NPDB
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Relates to adverse actions against licenses
Both were meant to track practitioners,
(and providers and suppliers in the case of
HIPDB) who have run into problems in
practice
Both impact geographic mobility of
providers
HIPDB- think FRAUD
NPBD- think MALPRACTICE
NPDB Section 1921
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New in 2010
Expands information collected to include
allied health care professionals
Makes information available to more groups
Expands reporting requirements
Requires all adverse actions, not just those
related to professional competence or
conduct
Data Bank will determine if report is under
NPDB or HIPDB of BOTH- more overlap
Website
www.npdb-hipdb.hrsa.gov
Take Home Messages
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Treat your patients well and be
loyal to their relationship with
you
Do not engage in falsification
of claims or false
representations to patients
Remember that dentistry is a
caring health care profession
bound by a professional oath
to put our patients’ interest
above our own
We are morally, ethically,
professionally and legally
bound to integrity and good
treatment in our relationships
with our patients.
If you follow these tenets,
the chance that you will be
sued or have your name
entered into a data bank
are low.