Ethics & Professional Standards Flashcards
7 cards from real CDC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Ethics & Professional Standards flashcards as text
A dental consultant is approached by a provider asking for 'inside information' about claim review criteria. The ethical response is to:
Answer: Decline and explain that proprietary review criteria cannot be disclosed
Proprietary claim review criteria are confidential; sharing them would compromise the integrity of the review process and create unfair advantages.
Which of the following is the most appropriate action when a dental consultant is unsure whether a procedure meets medical necessity criteria?
Answer: Request additional clinical documentation or seek peer consultation
When uncertain, requesting additional documentation or peer consultation ensures an evidence-based, ethical determination.
The concept of 'informed consent' in dental treatment requires all of the following EXCEPT:
Answer: Patient's guarantee to accept the recommended treatment
Informed consent requires disclosure, comprehension, and voluntary agreement — it never requires the patient to accept any specific treatment.
A dental consultant discovers their employer has been systematically denying claims based on an unlawful internal policy. The whistleblower protection most relevant to this situation is provided under:
Answer: The False Claims Act (qui tam provisions)
The False Claims Act's qui tam provisions allow and protect individuals who report fraud against federal programs, including systematic unlawful claim denials.
When a dental plan uses a 'least expensive alternative treatment' (LEAT) policy, ethical application requires that the consultant:
Answer: Clearly communicate the policy to enrollees before treatment so they can make informed choices
Ethical LEAT application requires proactive disclosure so patients can make informed financial and clinical decisions before treatment begins.
A dental consultant reviewing a malpractice-related record request should be aware that disclosing records in litigation contexts generally requires:
Answer: A valid patient authorization or a court order/subpoena
Records involved in legal proceedings require a valid authorization signed by the patient or a legally compelled court order/subpoena.
Which of the following behaviors would constitute a breach of the dental consultant's duty of confidentiality?
Answer: Sharing identifiable patient records with a spouse who is not involved in healthcare
Sharing identifiable patient information with an unauthorized individual, even a family member, is a clear breach of confidentiality and HIPAA.