Code of Ethics

Code of Ethics

Preamble:

A professional organization has the obligation to be self-regulating. Implicit to this concept is the assumption that said organization will have a written code of ethics that provides guidance for the appropriate conduct of its members.

A code of ethics identifies the principles that underlie professional behavior. It guides individual professionals and serves as evidence that a professional discipline is worthy of the public's trust. Codes of ethics are beliefs that establish standards of professional conduct within a society. Professional conduct is the action that is appropriate for the individual, the community and civilization, performed without concerns for personal benefit.

The American Association of Dental Consultants (AADC) has a stated purpose of promoting ethical conduct and continued competency of its members based upon standards of practice and current and accepted scientific literature.

The purpose of developing these guidelines is to provide guidance to individual members of the AADC, assist in the education of members who are new to the organization and provide an institutional memory when faced with challenges.

The AADC includes members who agree to uphold, abide by and promote the AADC Code of Ethics and Standards of Professional Conduct. This code is aspirational and not a legal instrument. It describes principles and beliefs inherent to the practice of a professional dental consultant retained by an insurance carrier, a self-insured plan, an insurance administrator or a commercial consulting entity.

Principle 1: Autonomy

"Self-Governance"

The dental consultant has a duty to respect the self-determination and confidentiality rights of patients, providers and peers.

Standards of professional conduct:

1A. The dental consultant should make every effort not to interfere with the doctor patient relationship unless such a relationship could jeopardize the public health or cause harm to a specific patient.

1B. The dental consultant should maintain the confidentiality of patient records while in his/her possession.

1C. The dental consultant should support the rights of patients, providers, peers and employers as defined under specific terms of applicable contracts.

Principle 2: Nonmaleficence

"Do no harm"

The dental consultant has a duty to the patient and the plan purchaser that the treatment or proposed treatment is in the best interest of and necessary for the patient and within the limits imposed by group service agreements. (i.e., alternative treatment provision rulings)

Standards of professional conduct:

2A. The dental consultant should seek a second opinion of a peer or specialist when rendering a decision with uncertainty.

2B. The dental consultant should not knowingly coerce a patient, provider, peer or employer or limit the information available to them for making an informed decision.

2C. A dental consultant should not perform his or her duties while under the influence of a controlled substance, alcohol or other chemical agent that impairs his/her abilities to perform those duties.

2D. A dental consultant with the first-hand knowledge of a peer or a provider practicing under the influence of controlled substances, alcohol, or other chemical agent has an ethical responsibility to report such evidence to the appropriate governing body of the company or professional society.

2E. A dental consultant shall act and speak on a high professional level so as to never bring discredit to the dental consulting profession.

Principle 3: Beneficence

"Do good"

The dental consultant has a duty to promote the welfare of the patient, provider, peer and employer to the best of his/ her ability within the limits of his/her contractual obligations.

Standards of professional conduct:

3A. The dental consultant should work toward the goals of the company or entity that employs said consultant and enforce the parameters of the policies issued by that body including its specific code of ethics.

3B. The dental consultant reviews strangers. It is said consultant's ethical duty to these strangers to view that brief and indirect relationship as one in which he/she is encouraged to do the most good for them as possible within the context of the plan and the standards of care relating to the proposed treatment.

3C. Dental consultants have an obligation to use their skills, knowledge and experience for the improvement of the dental health of the public.

3D. Dental consultants are encouraged to be leaders in their profession and conduct themselves in a manner to honor that profession.

3E. All dental consultants should abide by the American Dental Association Code of Ethics.

3F. The dental consultant shall be obliged to report to the proper authorities suspected patterns of child abuse.

Principle 4: Justice

"Fairness"

The dental consultant has the duty to be fair and non- prejudiced in all dealings with patients, providers, peers and employers.

Standards of professional conduct:

4A. The decisions a dental consultant makes are subject to the same ethical, moral and educational standards used in the direct treatment of patients.

4B. The ethical aspects of a dental consultant duties must always take precedence over economic aspects.

4C. The doctor-patient relationship, even indirect, is fiduciary (Latin for "to trust" ) and must take precedence over economic or personal influences.

4D. The dental consultant must regard "standard of care" the same for all providers.

4E. The dental consultant shall be obliged to report to the appropriate reviewing agency evidence of impairment, incompetence, illegal or unethical behavior on the part of a provider or peer.

The three elements of accusation:

  • Dissent- The dental consultant must weigh the potential harm to future patients treated by the provider in question or harm caused by case review by the consultant in question. The following questions must then be answered: How accurate is the information? What will produce the most good with the least harm? Have all existing and less drastic avenues for change been tried in a timely manner?
  • Disloyalty- The dental consultant must ask the question "Am I being excessively loyal to the patient, the provider, my fellow consultant or my employer?"
  • Accusation- The dental consultant must ask the questions: "What are my motives? Do I have a vested interest in this case? Is the criticism justified and supported by scientific literature? Does a pattern exist or is this an isolated case?"

4F. The dental consultant must determine the appropriate level of review, taking into account contract provisions such as the permissibility of post-treatment review, sequence of review-provider, patient, plan appeals process, peer review, state dental board, National Practitioners Data Bank and or legal authorities.

Principle 5: Veracity

"Truthfulness"

The dental consultant has the duty to be truthful in all direct and indirect communications with patients, providers, peers and employers.

Standards of professional conduct:

5A. The dental consultant must disclose any conflicts of interest that would compromise or influence his/her dealings with a patient or provider under review, a peer or the entity that employs him.

(One such potential conflict of interest would arise when the consultant is employed by a plan for which he/she is also a provider or a member of a group of plan providers. Another potential conflict could arise with review of claims involving family or friends.)

  • In such instances another consultant should be designated to review such claims. This review must meet the same criteria and thresholds that apply to all reviews.

5B. A dental consultant who presents educational or scientific information either written or in person must disclose any conflicts of interest or vested interests that would compromise or influence his/her impartiality.

  • A dental consultant must disclose any profit gained when endorsing a product for a manufacturer.

5C. The dental consultant must not knowingly use false or misleading information or credentials for purposes of obtaining employment or promoting his/her career.

5D. The dental consultant shall only use earned universally recognized and accredited health or non-health degrees when representing himself/herself to the public. The use of the certification COC or Certified Dental Consultant is appropriate when all requirements for said certification are met.

5E. The dental consultant must not imply by commission or omission that he/she is employed by an insurance carrier, a self-insured plan, an insurance administrator or a commercial consulting entity when in fact he/she is not.

5F. The dental consultant has an ethical obligation to understand the terms of all contractual arrangements with providers and patients under review.

5G. A dental consultant must not be the author of and/or present course material which encourages abusive, fraudulent or aggressive "over the line" reporting of services rendered on claims.

Principle 6: Fidelity

"Honor your commitments"

The dental consultant shall abide by the rules of his/her employer

Principle 7: Tolerance

"Respect the rights of individuals regardless of personal, ethnic, religious or cultural background in all dealings with patients, providers, peers and employers"

Principle 8: Compassion

"Be sensitive to and empathize with individual and societal needs in all dealings with patients, providers, peers and employers"

Principle 9: Competence

"Strive to achieve the highest level of knowledge, skill and ability within your capacity"

Standards of professional conduct:

9A. The dental consultant has an obligation to employ or direct (if in his/her area of responsibility) individuals qualified to perform required tasks.

9B. The dental consultant has the obligation to be knowledgeable of all procedures he/she reviews.

Principle 10: Professionalism

"Be committed to involvement in professional endeavors that enhance knowledge, skill, judgment and intellectual development for the benefit of society.”

Standards of professional conduct:

10A. The dental consultant should strive to assist patients, providers, peers and employers in receiving and delivering the highest quality care available under the terms and guidelines of a particular contract.

10B. A dental consultant may never use his/her position or knowledge to knowingly cause harm to a peer, provider, present or previous employer.

Principle 11: Integrity

"Incorporate core values as the basis for ethical decision making and the foundation for honorable character."

Conclusion:

To implement this "Code of Ethics" a level of compliance needs to be established. A separate ethics committee should be formed to rule on violations of the Code. These actions could be as follows:

  • letter of censure
  • suspension of membership in the AADC or revocation of privileges for a specified period of time.
  • expulsion from membership.
  • other sanctions as deemed appropriate by the Board

Ethics Complaint Rules and Procedures:

  • Timely complaint filed.
  • Screening committee reviews.
    • determines worthiness of complaint. If unworthy complaint is dismissed.
    • if legal redress pending complaint decision can be postponed.
  • If complaint is worthy of consideration, copy is sent to respondent for reply.
    • if no reply, charges are assumed true.
    • if reply submitted, copy sent to Ethics Committee.
  • Ethics Committee reviews case, renders decision, notifies parties. Deadline set for evidentiary hearing request.
  • If neither party requests hearing, the Ethics Committee decision becomes final and binding.
  • If either party requests a hearing a hearing panel is appointed, date set, and all parties notified.
  • Hearing panel hears evidence and renders a final and binding decision.