ETHICS EXAM - COMPLIANCE AND
HIPAA QUESTIONS AND ANSWERS
WITH SOLUTIONS 2024
Ethics - ANSWER values that come from social responsibilities
-CULTURE THAT EXISTS
-VALUE SYSTEM
Compliance - ANSWER rules and regulations that exist
-LOCAL AND STATE LAWS
-HELPS DEFINE WHAT IS RIGHT AND WRONG
What are three areas of compliance that are extremely prevalent to dentistry? - ANSWER -HIPAA
-Healthcare Billing
-Consent to treat
Why is it important to develop patient trust? - ANSWER patient trust is clinically important and a means
of developing positive outcomes. As patients understand that their information will be appropriately
safeguarded, the more patients are willing to discuss their symptoms, conditions and past and present
risk behaviors.
When in a time crunch we can leave all the paperwork to the end of the appointment? T or F? - ANSWER
False
Consent to Treat - ANSWER -Indiana law requires that a individual must give their informed consent for
the practitioner to provide health care services to the individual.
-At IUSD, the individual is asked to SIGN A WRITTEN DOCUMENT as evidence that consent was
appropriately given
-Specific rules apply if the patient is a minor (under 18) or not mentally competent to consent
What are some potential consequences of not getting consent? - ANSWER -malpractice litigation
, -civil assault and battery charges
What is an example of an assault and battery charge of a dentist in 2012? - ANSWER Boston dentist
sentenced to 1 year in prison for assault and battery - used paper clips as posts in root canal
4 Healthcare Billing Fraud and Abuse Laws - ANSWER -False Claims Act
-Anti-Kickback Statute
-Physician Self-Referral Statute - known as the "Stark" Law
-Civil Monetary Penalties Law
What is "fraud"? - ANSWER -an intentional statement or action that you know is false with the intent to
deceive another that could result in a benefit to you
What is the difference between fraud and abuse? - ANSWER Fraud - to PURPOSELY bill inaccurately
Abuse - items or services that are BILLED BY MISTAKE and the provider FAILS TO TAKE REASONABLE
EFFORTS to detect and correct the mistake.
Our patient is in need of reduced fees for service. If we have a procedure code that has a lower fee and is
close to the procedure we actually provided, we can use the lesser procedure code with the lower fee to
charge the patient the lower amount? T or F or depends? - ANSWER False
What does deliberate ignorance =? - ANSWER liability
Fraudulent/Abusive Behavior - ANSWER -billing for services that were not provided
-billing for services that were not medically necessary
-upcoding - altering claims to obtain a higher reimbursement amount than what was performed
-billing for duplicate services
-billing for services that are not covered
-false representation of when, what, and who performed the services
-receiving kickbacks, bribes or rebates
HIPAA QUESTIONS AND ANSWERS
WITH SOLUTIONS 2024
Ethics - ANSWER values that come from social responsibilities
-CULTURE THAT EXISTS
-VALUE SYSTEM
Compliance - ANSWER rules and regulations that exist
-LOCAL AND STATE LAWS
-HELPS DEFINE WHAT IS RIGHT AND WRONG
What are three areas of compliance that are extremely prevalent to dentistry? - ANSWER -HIPAA
-Healthcare Billing
-Consent to treat
Why is it important to develop patient trust? - ANSWER patient trust is clinically important and a means
of developing positive outcomes. As patients understand that their information will be appropriately
safeguarded, the more patients are willing to discuss their symptoms, conditions and past and present
risk behaviors.
When in a time crunch we can leave all the paperwork to the end of the appointment? T or F? - ANSWER
False
Consent to Treat - ANSWER -Indiana law requires that a individual must give their informed consent for
the practitioner to provide health care services to the individual.
-At IUSD, the individual is asked to SIGN A WRITTEN DOCUMENT as evidence that consent was
appropriately given
-Specific rules apply if the patient is a minor (under 18) or not mentally competent to consent
What are some potential consequences of not getting consent? - ANSWER -malpractice litigation
, -civil assault and battery charges
What is an example of an assault and battery charge of a dentist in 2012? - ANSWER Boston dentist
sentenced to 1 year in prison for assault and battery - used paper clips as posts in root canal
4 Healthcare Billing Fraud and Abuse Laws - ANSWER -False Claims Act
-Anti-Kickback Statute
-Physician Self-Referral Statute - known as the "Stark" Law
-Civil Monetary Penalties Law
What is "fraud"? - ANSWER -an intentional statement or action that you know is false with the intent to
deceive another that could result in a benefit to you
What is the difference between fraud and abuse? - ANSWER Fraud - to PURPOSELY bill inaccurately
Abuse - items or services that are BILLED BY MISTAKE and the provider FAILS TO TAKE REASONABLE
EFFORTS to detect and correct the mistake.
Our patient is in need of reduced fees for service. If we have a procedure code that has a lower fee and is
close to the procedure we actually provided, we can use the lesser procedure code with the lower fee to
charge the patient the lower amount? T or F or depends? - ANSWER False
What does deliberate ignorance =? - ANSWER liability
Fraudulent/Abusive Behavior - ANSWER -billing for services that were not provided
-billing for services that were not medically necessary
-upcoding - altering claims to obtain a higher reimbursement amount than what was performed
-billing for duplicate services
-billing for services that are not covered
-false representation of when, what, and who performed the services
-receiving kickbacks, bribes or rebates
