Potential Legal Risks Associated wtih Groupon

With the explosion of social media and online marketing, members of the dental community “must” be aware of the risks associated with the new marketing.  While dental practices have successfully utilized the services of Groupon to attract new patients, there are growing concerns regarding this type of marketing.  The American Dental Association has recently published its opinion on the Groupon issue.  Before a dentist participates in a Groupon marketing campaign, they must be aware of potential ramifications. 


A dentist utilizing Groupon to offer discounts to new and current patients will split a portion of the revenue generated from the promotion with Groupon.  Many states have regulations that prohibit fee splitting between a dentist and a third party.  A violation of the state regulations could result in the dentist facing censure and reprimand, fines, suspension, and even license revocation.

Federal Anti-Kickback Statute

The federal anti-kickback statute, 42 U.S.C. § 1320a-7b(b) generally prohibits a dentist from offering or paying remuneration to induce a person to refer a patient that may be eligible for services under a federal health care program, including Medicare or Medicaid.  A dentist violating federal law could be charged with a felony and subject to fines, imprisonment, and exclusion from federal health care programs. 

Most Favored Nations Clause

The terms of a dentist’s contract with third party payors [insurance carriers] may pose problems with the offer and award of Groupon’s discounts to patients.  Many insurance contracts provide that the dentist must provide the insurer with the best price that the dentist charges for a particular service (a “most favored nations” clause).  Providing a discounted rate to Groupon customers may breach the most favored nation provision in an insurance contract.  As a result, the dentist may be required to offer the same discount to the insurer’s patients.

ADA Ethical Rules

According to the American Dental Association Principles of Ethics and Code of Professional Conduct Section 4.E. Rebates and Split Fees, dentists “shall not accept or tender ‘rebates’ or ‘split fees’”. 

Dental Boards

Most dental boards provide that a dentist “shall not give rebates or split fees with a referral source”. 

Before a dentist enters in to or starts any type of marketing campaign [or social media campaign], they should seek legal advice as to the application of state and federal laws, the most favored nations clause, ADA Ethical rules and Dental Board rules.  While the marketing of any dental practice is important, an ill-advised marketing campaign could result in a dentist being censured, reprimanded, fined, suspended, and lose their license. 

Oral Cancer: Risk Management Considerations

Due to the increasing public concern regarding oral cancer, it is important for dentists to be aware of proper patient assessment and documentation procedures so that they may provide timely and proper treatment to their patients.  This article will provide some insight into potential claims and also provide risk management advice to help avoid these problems.

Oral Cancer Statistics

The U.S. Department of Health and Human Services states that oral pharyngeal cancers affect around 30,000 people per year in the United States, with around 8,000 of those cases resulting in death.  Most cases which result in death occur in people over 40 years of age and those with a history of smoking, regular alcohol use, or both.  Men are more likely than women to develop oral cancer.  A good deal of malpractice claims against dentists in the United States involve oral cancer cases. The complaints range from failure to diagnose to improper post-treatment dental care. 

Correct Patient Assessment

When assessing a patient and planning a treatment strategy, dentists should first carefully review the patient’s medical history to note any predisposing oral cancer factors.  Next, a comprehensive oral evaluation should be completed. This includes careful intraoral and extraoral examinations, including all parts of the tongue, floor of the mouth, the hard and soft palates, and palpitation of the nodes.

This full examination should be followed with a review of oral radiographic images in order to note any potential abnormalities in the bones and dentition of the patient.  The dentist should be sure to carefully and clearly document each area examined in the patient’s permanent record.  All abnormalities should be noted along with notation of all normal areas, as well. 

If an abnormality or suspicious lesion is found during the examination, the dentist should either properly refer the patient to a specialist for further examination and diagnosis or schedule the patient for a re-evaluation.  Failure to do one of these two procedures in a timely manner can result in more severe medical or dental consequences for the patient. 

Proper Documentation

In order to satisfy the basic standard of care, all dentists are required to perform these evaluations and note all the results from the examination in the patient’s permanent record. 

The dentist should further understand the need to take special precautions throughout treatment for certain medical conditions, including oral cancer.  This includes before, during, and after treatment of the patient.  When dealing with oral malignancies, these precautions may relate to the surgery, chemotherapy, or radiation therapy which a patient might be undergoing. 

In cancer cases, it is crucial that a treating dentist contact the patient’s oncologist to determine if any special precautions should be taken for the patient before and after undergoing medical treatment, such as chemotherapy. It is also essential that the medical history dictated in the patient’s record include information regarding whether or not the patient has undergone such medical treatment.  This record should also note any necessary precautions that should be taken in regard to the patient’s dental care.  Failure to take into account the patient’s medical condition and the necessary precautions because of the patient’s medical condition when providing treatment can result in complications involving both the dental and the medical care of the patient.  This, in turn, could provide a basis for a malpractice claim against the dentist.


Dentists must carefully follow all procedures in the practice in order to help them avoid legal pitfalls.  Properly assessing and examining the patient and documenting the patient’s record will not only keep the dentist out of legal trouble, but it will also provide the patient with positive dental care service.  In the case of oral cancer, following the proper procedures may allow a dentist to observe the abnormality in a timely manner, thus creating a better prognosis for the patient.

Dental Practice Audits

Dental audits were rare at one time.  Now, however, with insurance companies and third party payers auditing more routinely, it is much more likely that a dental practice will fall victim to an audit.  Most dental practices that are contracted with dental plans are audited at least once during the course of their practice.  Many of these dentists are left wondering why audits are becoming a more routine exercise of third party payers.  The answer: alarming statistics.  The Federal Bureau of Investigation estimates that ten percent (10%) of the money expended on health care is due to fraudulent activity.  Insurance companies estimate that fraudulent health care billing represents up to $10 billion each year. 

In addition, Medicare fraud is becoming more rampant.  The United States General Accounting Office estimated that out of every $7 spent on Medicare, $1 is lost to Medicare fraud.  Fraud is adding enormous costs to the nation’s health care system.  As more and more fraudulent health care charges rack up for insurance companies to pay, insurance companies are becoming serious about auditing health care practices.  With a thorough understanding of the audit process, dentists will be better prepared for what appears to be the inevitable. 

After receiving notice of an impending audit, dentists often wonder why their practice has been targeted.  Generally the audits conducted by dental plans and third party payers are a method of showing state regulators that the patients are receiving quality care.  A third party payer is an organization other than the patient (which would be the first party) or health care provider (also known as the second party) involved in the financing of health care services. The audits are typically meant to check the status of a dental plan and are not meant to be a check on the specific dental practice.  The selection process third parties undertake to audit a given dental practice varies.  Third parties may randomly pick dental practices on the basis of how likely the practice is to have discrepancies once audited.  The third party’s goal is to recoup lost dollars, and so this strategy is chosen to allow a third party to obtain the largest return. 

A dental practice is most likely to be audited after submitting atypical claims online.  Each claim submitted is analyzed by a third party payer.  The auditors flag abnormal or atypical charges, as these may suggest provider abuse.  Additionally, third parties track information on practice charges by analyzing the average cost per claim, average cost per person, and how often certain treatments are performed.  With this information, the third parties target specific dental practices for an audit. 

Auditors typically share common goals.  By conducting audits, third party payers are attempting to prevent abuse of the payment system.  By performing audits on practices, dentists are forced to understand the importance of keeping records and submitting only honest and accurate claims.  Also, dentists are more likely to keep accurate records and submit truthful claims when they know an audit may be lurking than if they assume their dental practice will never fall victim to an audit.  A second goal ties in with the first, and that is to help dentists understand and follow the third party payer’s guidelines.  Finally, the auditors are trying to find instances of overpayments to dental practitioners for claims the dental practice has submitted. 

Many dentists want to know what to expect if their practice gets hit with an audit.  First, the dentist will most likely be notified of the impending audit by a letter, however the third party payer may make initial contact with the dental practice by telephone.  When a telephone call takes place, a day and time for the audit will be arranged, and the dentist should ascertain what type of audit will be conducted.  It is also advisable to ask why the audit is being performed.  The answer may be that it was simply a random selection, but a dental practitioner should make certain that it was not because of a claim submission that the third party payer flagged as abnormal.     

When auditing the dental practice, the insurance plan will most likely send representatives to the dental practice to ensure that billing claims match documentation in patient files.  Auditors will analyze whether amounts paid to the practice were for an actual member of their insurance plan, whether the services rendered were actually provided according to treatment plans, and whether the services provided by the dentists were in accord with federal law. 

Additionally, auditors may analyze patient files.  Auditors may be interested in reviewing patient medical histories, dental histories, documentation of oral examinations, treatment notes, diagnosis, procedures completed, the outcome of each procedure, and follow-up care. It is also possible that documentation supporting submitted claims will be requested during an audit.  Problems encountered during audits are most likely to be caused by improper documentation of records rather than by fraudulent billings.  The dentist is typically without recourse if the records in the patient file do not match up with the claims billed. 

Various state laws and the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule permit third party payers to access and review the health records of their own members.  However, third party payers are no longer permitted to access the records of patients who are not enrolled in their plans like they were in the past.  Therefore, third party payers are no longer able to compare their enrollees’ records and charges with those of patients not enrolled under their plans.

Aside from auditing the patient files, the third party payer may also access the quality of the facility, the maintenance of the equipment, the level of difficulty patients on their plan encounter in obtaining appointment times, and the level of compliance with federal regulations during the course of the audit.  It is prudent that the dentist remains with the auditor at all times.  It is worth the time to clear the calendar on the day of the audit and to stay with the auditor as patient and billing records are reviewed.  Also, the staff of the dental practice should be prepared for the audit, and the dentist should discuss the procedures to be followed prior to the day it is conducted.

Since dental audits are becoming a routine part of doing business, dentists must protect their practice by preparing their office for an audit.  To prevent audit problems, dentists should make themselves aware of terms of any third party contracts, keep the plan manuals in a safe place so the dentist can refer back to them, ensure each procedure performed matches the procedure billed, and ensure that all patient records are organized and contain all relevant information on each patient.  Also, when claims are filed online, ensure that the correct price is sent to the third party insurer.  With a more thorough understanding of third party audits and the third party payer’s motivation for conducting them, dentists will be more likely to avoid costly mistakes.

The Importance of Privacy

Privacy is something we all value. Especially with new discoveries in the link between good oral hygiene and overall medical health, it should not come as a surprise to anyone that dentistry patients want to ensure more than ever that their personal information will not be shared with anyone without a legitimate need to know.  Under the US Department of Health and Human Services (HHS.gov), HIPAA Rules were created to ensure that all healthcare professionals respect and protect a patient’s privacy.   How well does your office comply with HIPAA guidelines?


The Health Insurance Portability and Accountability Act (HIPAA) became law in 1996.  HIPAA provides federal protections for personal health information held by patients. The HIPAA privacy rule does permit the disclosure of personal health information needed for patient care and other important purposes related to a patient’s care.  The Security Rule under HIPAA specifies a series of administrative, physical, and technical safeguards or security measures required for covered entities (dental offices that transmit patient information in electronic form) to assure the confidentiality, integrity, and availability of electronic protected health information. 

The Privacy Rule establishes a federal requirement that dentists and other medical practitioners obtain patient consent before using or disclosing a patient’s personal health information for treatment, payment, or healthcare operations. 

Private health information, also known as PHI, is any information relating to a patient’s health, treatment, or payment for healthcare that identifies a patient.  Private health information includes, but is not limited to: names, addresses, phone numbers, fax numbers, e-mail addresses, credit card information, certificate numbers, license numbers, account numbers and birth dates. Many dental employees, including dental assistants, dental hygienists, lab technicians and front office staff, may come into contact with PHI.  PHI should be carefully secured and traced throughout the dental office. 

Although compliance ismandatory only for “covered entities”, the American Dental Association suggests that dentists who are not covered entities adopt the same privacy practices. It is still possible that the HIPAA privacy laws may establish an industry standard among dental practices and failure to comply with the industry standard may result in liability.

How is PHI stored in our office?  Who is authorized to access the information?  How is the information stored and how is it secured?  How and when is this information destroyed?  Where in the office is it appropriate to discuss personal health information?   Do we have an adequate and recorded procedure for training?

Answers to these questions cannot be left to interpretation; healthcare providers must adopt privacy procedures for their offices, ensuring that patient records are kept in a secure space and that employees are trained on privacy policies, making records inaccessible to those who do not have a legitimate need to view them. Most of the information gathered on patients requires these security measures.  Thus, the entire dental office must be aware and held responsible to avoid costly violations. 

HIPAA Violations

Failure to comply with HIPAA can result in both civil and criminal penalties.  These penalties vary based on the nature of the violation and the extent of the resulting harm.  Healthcare entities and individuals who obtain or disclose individually identifiable health information face a penalty ranging from $100 to $50,000 per violation, as well as imprisonment up to one year.  However, offenses committed with intent to use the information for personal gain, harm, or commercial advantage face a more serious fine of $250,000 and imprisonment for up to ten years.  Also, if a state has privacy laws more stringent than the federal regulations, the state laws will supersede HIPAA.

It is important to note that not only are employers held liable – employees who knowingly violate a HIPAA rule may be subject to a criminal penalty as well.

Dental Advertising

Dentists have a right to promote their practices through various forms of advertising. However, ethical guidelines regarding advertising must followed. Section 5 of the American Dental Association’s Principles of Ethics and Code of Professional Conduct sets forth certain standards in part by stating that no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading in any “material” respect.

This standard has been implemented in order to protect the general public from false and misleading advertising that may induce a patient to seek dental services from a particular office. Although some states may not have adopted Section 5 of the ADA’s Principles of Ethics and Code of Professional Conduct, Section 5 sets forth a good guideline that all dentists should follow. The fundamental issue in dental advertising is whether the advertisement is false or misleading in any material aspect.

The first step to ensuring compliance with ethical advertising is to understand advertising regulations, standards and the law. With a proper understanding, dentists will be able to market their practices and also avoid legal problems associated with perceived false or misleading advertising. Some dentist practices have already began to implement these legal strategies, Columbia Dental has been known to be one of the first to follow the new published regulations.

Rules that govern the marketing of businesses [including dental practices] are generally enacted by the Federal Trade Commission. There are various forms of marketing, such as advertising in magazines, newspapers, billboards, Vinyl Banners, on the internet, radio, or even television. The Federal Trade Commission is constantly monitoring advertisements, which includes dental advertising.

Dental advertisements must be truthful and non-deceptive. For an advertisement to be completely truthful, it must have evidence to back up each assertion of fact. An advertisement is non-deceptive if it is not likely to mislead a reasonable consumer and does not omit any necessary information for the consumer to make an informed decision regarding whether to obtain services at a specified dental practice. Regardless of the claim, all material information must be disclosed in a manner that a reasonable consumer could understand. Disclosures, if typed, should be in a size large enough for a consumer to clearly read, and failure to comply with this requirement may result in the disclosure being deemed inadequate. Furthermore, an asterisk or other symbol should be used to call attention to the disclosure, especially if the disclosure is placed at the bottom of the advertisement.

In order to determine if an advertisement may be of a concern to the Federal Trade Commission, the advertisement must be considered in its entirety. Even if all of the statements in the advertisement are true, but the pictures are deceptive, then the advertisement may violate the Federal Trade Commission’s advertising standards [and the advertisement may also violate the guidelines set forth by a particular state dental board or state law]. Also, the advertisement should not imply something other than what the advertisement is intending to communicate.

Advertisements that incorporate statistics must be accurate. If a dental advertisement is using statistics, then there must be accurate data to back up the advertising assertion. The Federal Trade Commission requires dental claims regarding consumer health to be supported by reliable scientific evidence and medical data. This evidence may include research, studies, tests, and analysis, which are conducted by dental experts and professionals in an objective manner

Obviously, non-factual, silly claims or jokes contained in a dental advertisement which no reasonable person could possibly regard as harmful will not be considered false and misleading.

The Federal Trade Commission has extensively regulated claims such as price reductions. Dentists should be aware of the relevant standards for this type of advertising. First, if a former price is specified in an advertisement, the price must be the actual price of the goods or services offered for a reasonably substantial amount of time, and on a regular basis. If a former price is not specified, and a sale price is announced, the sale price must be such that a reasonable person with knowledge of the former price would regard the goods or services as a legitimate savings.

Next, if a specific dental advertisement compares the prices of one dental practice to another [yes, this actually does occur], then the competitor’s prices that are listed in the advertisement “must” be the actual prices charged by the competing dental practice. Falsely stating the price of services for a competing dental practice in an advertisement is considered misleading and deception advertising.

Obviously, truthful advertising is important to both the American Dental Association and to Federal Trade Commission. All states have laws that prohibit false, deceptive or misleading dental advertising. If a dentist violates certain rules and regulations regarding the prohibition of false and deceptive advertising, then the violation could result in a fine, injunction, censure, suspension or revocation of a dentists license. Clearly, dentists who advertise must comply with the Federal Trade Commission, and each dentist must also comply with their own state law [and dental board requirements ]regarding advertising.

With the explosion of the internet, many state dental boards are taking an “active” role in monitoring dental advertising on the internet. A growing area of concern regarding advertising on the internet is that dentists are claiming they are specialists in areas that are not considered or recognized as specialty areas. For example, if a particular state dental board does not recognize cosmetic dentistry as an area of specialty, and a dentist advertises on the internet that they are a “specialist” in the area of “cosmetic dentistry”, then that particular state dental board may consider the advertisement as false and misleading, which could result in disciplinary sanctions against that particular dental.

Also, “buffing” ones credentials on the interest [or any other form of advertisement] may be considered a violation of certain advertising rules as set forth by a particular state dental board. If a dentist claims that they are a “nationally recognized expert in implant dentistry”, the advertisement may be concerned deceptive advertising.

The rule of thumb for dental advertising is that a dentist must be fully aware of their own state regulations regarding advertising, and every dentist should review the guidelines as set forth by the American Dental Association, even if a particular state has not adopted the ADA’s guidelines.

Simple Estate Planning for Dentists

Statistically, seventy percent (70%) of all dentists will die without a Will, and that number could be higher for dentists who fail to implement tax saving strategies during their lifetime. A failure to plan could directly affect the amount of estate taxes your estate may be required to pay to the IRS, and the amount of taxes you may be required to personally pay on a yearly basis. In some cases, estate taxes may be substantial.

Outlined below is essential estate planning and tax information you need to know today, so you can plan for tomorrow.

  1. Make a Will. You should state precisely who will receive your property at the time of your death [i.e. spouse, children, etc.]. If you have minor children you should appoint a guardian for your children. By preparing a Will, you not only plan for the distribution of your property, but you also plan for your children’s future.
  2. Consider a trust. There are two kinds of trusts, an Irrevocable Trust and a Living Trust. An Irrevocable Trust may be used for a variety of reasons, such as to avoid potential estate taxes, as well as asset protection. If you need to Buy a million dollar life insurance policy, one of the easiest ways to avoid estate taxes on your life insurance proceeds is to establish an Irrevocable Life Insurance Trust [ILET]. A properly prepared life insurance trust may protect your life insurance proceeds from estate taxes. A living trust is used to control your property while you are living, and also to avoid probate.
  3. Make health care directives. By creating a healthcare directive, you will be able to set forth in writing your healthcare wishes and intentions. Unless you outline in writing your healthcare wishes and intentions [life support, coma, vegetative state], someone other than a loved one may be forced to make life and death decisions for you and get multiple quotes of different insurance companies.
  4. Make financial power of attorney. A general power of attorney will allow you to appoint a trusted person to handle your finances if you are unable to do so yourself. If you become incapacitated or disabled, who has the authority to handle the day to day operations of your dental practice?
  5. Protect your children’s property. If you have minor children, you should appoint a trustee in your Will [or Trust] to handle the disposition of your children’s property in the event of your death. If you fail to plan, your children may receive a substantial amount of property [land, dental practice, etc.] when they turn 18 years old. How long would $500,000.00 last in the hands of an 18 or 20 year old? Your Will [or Trust] should state what age(s) you wish your children to receive their property (21, 25, 30, etc.)
  6. File beneficiary forms. If you have a bank account or investment account, you may be able to designate a beneficiary for those accounts. Many bank and investment accounts are “pay on death accounts”, which will allow the funds in such accounts to be paid directly to your designated beneficiary. In most cases, “pay on death accounts” are excluded from the probate process.
  7. Consider life insurance. If you have substantial assets (home, investments, dental practice), you must have life insurance. However, in order to avoid estate taxes (which may be as high as 51% of your estate), you should consider establishing an Irrevocable Life Insurance Trust. If you are considering purchasing life insurance you’re going to be wanting to look into what the best policy could be for you.
  8. Understand estate taxes. If you have accumulated any type of assets whatsoever [house, bank account, investments, life insurance and especially a dental practice], you must take the necessary steps in order to reduce your estate taxes. You have worked hard all of your life, and if you fail to plan, your family may lose everything.
  9. Protect your business. If you are the sole owner of a dental practice or have a partner, you must have a business succession plan. A succession plan should specifically outline what happens to your dental practice or your ownership interest in the dental practice at the time of your death. If you have a partner, you must have a Shareholder’s Agreement.
  10. Store your documents. In order to ensure a smooth estate planning transition, the following records should be easily accessible: Will, Trusts, Insurance policies, Real estate deeds, Certificates for stocks, bonds, annuities, Information on bank accounts, mutual funds, and safe deposit boxes, Information on retirement plans, 401(k) accounts, or IRAs, Information on debts: credit cards, mortgages and loans, utilities, and unpaid taxes.

As the owner of a dental practice, you constantly deal with the day to day pressure [accounts receivable, employee problems, marketing, patients, etc.]. In the rough and tumble world of dental practice management, don’t forget to manage your own estate.

Hiring and Retention of Employees

One of the fastest areas of liability exposure for the dental profession is the negligent hiring and retention of employees.

If an owner of a dental practice fails to conduct a due diligence investigation of a potential employee prior to hiring that particular employee, better understanding of how to manage small business can help to mitigate this eventuality but if not, then the owner of the practice may be held liable for the negligent or intentional acts of that particular employee.

Prior to hiring an employee, the owner of a dental practice should conduct a due diligence investigation, which should include the following:

1. Performing a criminal background check;

2. Reviewing the driving history of a potential employee;

In general, negligent hiring is based upon the principle that an owner of a dental practice has an obligation to protect not only the employees, but also the patients. It would be a good idea to use services similar to ClearStar to carry out these employment checks.

If the owner of a dental practice fails to conduct a criminal background check on a new or existing employee, and that particular employee commits some type of criminal act against a patient [i.e., improper touching, credit card fraud, etc.], then the owner of the practice may be held liable.

A growing area of potential liability for the owner of a dental practice is the negligent retention of an employee.

If the owner of the practice discovers that an employee has committed a negligent or criminal act while employed at the practice, and the owner of the practice fails to take appropriate disciplinary action against that particular employee, the owner of the practice may be liable if the employee commits a subsequent act.

[Example: The retention of an employee after it is discovered that the employee improperly charged a patients credit card for personal use, or an employee had prior misconduct with a patient].

In today’s society, security is a big concern, especially in the area of domestic violence. The owner of a dental practice may have a certain legal obligation to protect his/her office staff and patients from potential danger.

If an employee is being harassed at work, either by a spouse, significant other, friend, etc., then the owner of the practice should make sure the harassment does not interfere with office operations, or place employees or patients at risk. For example, if a very heated verbal altercation occurs during office hours between an office employee and his or her spouse as a result of a pending divorce, the owner of the practice should immediately address any potential security concerns.

With a little due diligence and the implementation of proper office procedures, the owner of a dental practice should be able to avoid a great deal of liability exposure.

Informed Consent and the Minor Patient

All dentists should be aware that as a general rule, an unemancipated minor’s consent to treatment is not valid. The consent of a parent or legal guardian must be obtained before treatment is rendered. Unfortunately, many  dentists still provide “routine” dental treatment to their minor patients without obtaining informed consent from the parent or legal guardian of a minor child.

The informed consent process should be a complete and thorough discussion between the dentist and the patient – and the parent of a minor child – as to what procedures will be taking place, including, but not limited to, extractions, root canals, crown and bridge, implants, and incision and drainage. A written informed consent form should be obtained before treatment starts, including any  procedure involving flap reflection, cosmetic dentistry, TMD treatment, orthodontics and IV sedation or general anesthesia.

The informed consent process should include a discussion between the dentist (not just a staff member) and the patient about the nature of the treatment, potential risks and complications, likely benefits, prognosis, alternatives (including referral to a specialist when appropriate), timing and estimated fees.

The informed consent process does not necessarily have to be as detailed for routine diagnostic and treatment measures. However, the patient must be advised about all of the treatment and diagnostic procedures with respect to the proposed dental care, including what is to be done and why. The patient does have a right to refuse even the most routine treatment.

In the case of an unemancipated minor child who is unaccompanied by a parent or legal guardian to your office, you should take a few steps to minimize a potential conflict and reduce your liability exposure.

First, make a professional judgment as to whether any delay in treatment will likely be detrimental to the minor patient’s dental or systemic health. Ask yourself whether it is in the patient’s best interest to proceed with the treatment immediately, or whether treatment can wait until a parent or legal guardian can be contacted.

Next, make a reasonable effort to contact the parent or legal guardian. The patients chart should be updated with cell phone numbers.

A patient’s dental record should contain detailed documentation regarding all of the times you attempted to contact the patient’s parent or legal guardian.

However, if you cannot reach a parent or guardian, it may be prudent to defer routine treatment unless an emergency exists, until you can obtain a parent or guardian’s informed consent.

The verbal consent or signature on a consent form from the parents of a minor child should be sufficient. However, it is essential that the parent granting consent is legally authorized to do so. Divorces can often be highly contentious, to the point where some divorce decrees have stipulated that a non-custodial parent cannot make medical decisions. If a parent has no parental rights, then that parent  is precluded from granting consent on behalf of his or her minor child.

If an unaccompanied minor child comes for an appointment for simple or routine treatment that has already been discussed and consented to by the parent or guardian, it should be permissible to proceed with treatment. However, be very careful that you do not perform any treatment whatsoever outside of the prior consent.

Finally, I would suggest that all adult patients and parents or guardians of all minor children be required to sign an “Admission to the Practice Agreement.” This document provides for, among other things, the consent of the patient (or the patient’s parent or legal guardian) to routine dental procedures, as well as treatment and diagnostic tests, including x-rays, that are deemed necessary in the dentist’s professional judgment. If a conflict arises later, the signature of the parent or legal guardian on such a document will, at a minimum, demonstrate that implied consent was granted by the parent or legal guardian for  routine dental procedures for the minor patient.

Disaster Proof Your Veterinary Practice

Every veterinary practice is vulnerable to natural disasters such as fires, floods, and tornadoes. However, advance preparation can minimize your exposure in several ways. For example:

Physical Assets
Buildings, equipment, furniture, inventories, and supplies should all be protected by adequate property and casualty insurance. Be sure to review each policy for “named perils,” which are the disasters covered (such as floods or earthquakes). If your location is prone to one of the “perils” not listed, consider expanding your coverage or buying an additional policy to include it.

Business interruption insurance will reimburse you for lost profits, which will be computed from your financial records. Your policy should allow a realistic time period for recovery, even if it costs a little more.

Missing records can cause a host of problems, including making it hard to quantify your disaster losses. Duplicates of financial statements, patient lists, asset inventories, and other important data should be maintained in a secure off-site location and updated regularly. Important on-site documents should be stored in a fire-proof safe or vault.

Critical computer data should be duplicated regularly on portable hard drives or other storage media. Updated copies should be stored off-site.

Consider buying “extra expense” insurance to cover relocation costs for a quick post-disaster recovery. Also, you should identify alternative sources of operating assets (such as furniture and equipment lessors), and investigate other possible practice locations. Look into government disaster relief programs available to businesses in general and veterinarians in particular.

Managing Exposure After a Security Breach of Patient Information

If a security breach occurs in a dental practice, the practice owner must take the necessary steps in order to comply with federal law, in order to avoid a potential increase in liability exposure. 

Rules Requiring Patient Notification of a Security Breach

The U.S. Department of Health and Human Services (HHS) has issued strict regulatory guidelines that dental practice owners must follow in the event of a security breach. The Federal Trade Commission (FTC) has also issued breach notification regulatory requirements that dental practice owners must comply with, in the event of a security breach.

Breach Notification Requirements

Depending on the type of security breach and the extent of the breach, a dental practice owner must notify affected patients, the Secretary of HHS and the FTC [if applicable], and, in certain circumstances, the media.


If you are not familiar with the 2009 American Recovery and Reinvestment Act and the 2009 HITECH Act, your dental practice is probably not in HIPAA compliance. In fact, statistically, 85% of all dental practices are not in HIPAA Compliance.

Dental practices that have experienced a breach of patient protected health care information can significantly limit their legal exposure by complying with simple regulatory guidelines.

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