Risk Education

Please be on the alert for a “phishing”/ telephone scam where individuals posing as governmental officials contact SMPH providers by phone or email.  Recent scams have included people claiming to be Drug Enforcement Administration (DEA) agents, employees from the Wisconsin Department of Safety and Professional Services (DSPS) or sheriff’s deputies.

Example: DEA Scam Calls

For example, we have been alerted that SMPH providers have been recently targeted by individuals falsely claiming to be DEA agents. These individuals pose as a DEA agent with the intent of getting you to disclose confidential or personal information. The scammers threaten their target with criminal prosecution or professional discipline if their demands for information are not immediately complied with.

The DEA has posted a warning about this type of scam on their website: https://www.dea.gov/scam-alert. The DEA’s post confirms:

“DEA personnel will never contact members of the public or medical practitioners to demand money or any other form of payment, will never request personal or sensitive information, and will only notify people of a legitimate investigation or legal action in person or by official letter.”

What to watch for:

Warning signs of a potential scam/phishing effort can include:

• Unsolicited contacts demanding some of urgent or immediate response
• The scammer insists on immediate cooperation with their information demands to avoid some type of “punishment”
• The scammer may try to appear more legitimate by providing publicly available information (e.g. information that is publicly available on the Wisconsin’s Department of Safety and Professional Services (DSPS) website about medical professionals)
• The scammer may warn you that you cannot speak to others about their call (including an attorney) and may reference something that sounds like a statute or regulation
• The scammer asks for information – including about you, about colleagues, about the organization or about patients

You can also check on the official websites of organizations/entities like the DEA or DSPS for warnings about recent scam efforts or advice that the particular office has pulled together about scams related to them.

Additional resources about phone and email scams/phishing can be found at:

• https://it.wisc.edu/news/recognize-and-protect-yourself-from-phone-scams/
• https://it.wisc.edu/news/learn-how-to-recognize-and-report-phishing/

If you find yourself the target of this scam, you can report this to:

• E-mail: UW–‍Madison Cybersecurity Ops Center (CSOC), “Report Phish” in Outlook
• HIPAA incidents – report to Compliance (https://compliance.wisc.edu/hipaa/)

Situation:

• Dental injury is a known complication from both procedures and intubation processes
• Sometimes dental injury results in a patient complaint, grievance, a request to pay for follow-up dental care or for compensation

Background:

• Providers and staff may be unclear on how to respond to demands for compensation related to dental injuries
• Patient Relations can help with responding to patient complaints or billing questions if a dental injury occurs
• Risk Management can help provide information on mitigating risks of dental injury and related claims.

Assessment:

• Include in your pre-op and pre-procedure assessments a full dental history and current assessment of loose or damaged teeth, crowns, and implants. It is helpful to note that bridges and partials are be removed pre-procedure
• These assessments include asking the patient about susceptible teeth and performing a visual inspection.
• As part of the informed consent process, discuss with the patient, when clinically appropriate, the general risk of dental injury along with any identified specific risks. Document the discussion of these risks in the medical record.

Recommendations:

• Consider referring patients at high risk for dental injury to a dentist pre-procedure
• Evaluate the use bite blocks and other devices as indicated to reduce risks
• When a Dental Injury Occurs:
  • Enter a Healthcare Event Reporting Online (HERO) report
  • Encourage patients to follow up with their dentist and document discussion
  • Do not make promises or determinations about bills or compensation. (This needs to be assessed and providing incorrect information can have a negative impact)
  • If a demand for compensation or billing questions occur, consult Patient Relations.

Refer to Policy 1.3.3 Responding to Patient/Family Complaints and Grievances for additional information.

If a patient has continued concerns related to a dental injury work with the care team, department, Patient Relations and Risk Management to assess and respond to the concerns.

SMPH providers who encounter patient disruptive conduct in clinical situations may have questions about if and how to describe the disruptive conduct in the medical chart. It is appropriate to chart instances of conduct that impact the clinical setting that occur during care. Here are some suggestions to consider when describing disruptive conduct in a patient’s medical chart:

• Objective, factual descriptions: Chart disruptive conduct like you would for any other aspect of the clinical encounter. The documentation should be factual and objective.
• Separate your own emotions: Maintain a professional tone when describing the conduct. Do not allow your emotional response to the event negatively affect the tone of your entry.
• Describe, do not speculate: Avoid jumping to conclusions or making unsubstantiated subjective remarks in your chart note. Do not characterize the patient’s conduct, instead describe them objectively. Avoid non-clinical judgments about why the patient is acting in a disruptive way. Rely on your “five senses” for the details of your charted observations.
• Be specific with details: Avoid vague descriptions of the patient’s conduct. Use specific terms to describe things like tone/volume of voice, physical movements, or the timing/sequencing of events.
• Elements to include: In help provide a complete, objective and descriptive summary of the relevant aspects of disruptive conduct, consider whether to indicate things such as:
  • Was the conduct verbal and/or physical
  • How was the conduct disruptive? (Examples might include, but are not limited to: Did it cause physical harm? Threaten? Prevent or interfere with the care of the care of the patient or others?)
  • Where did the conduct occur? At what frequency/over what period of time? What were the observed triggers for the conduct or what preceded the conduct?
  • What instructions were given to the patient regarding the conduct and how did they respond? Was the patient informed that the particular conduct was inappropriate or unsafe, and that they needed to stop?
  • Avoid including irrelevant details: Avoid including details that do not factually describe what happened during the event. Irrelevant details could give the false perception that the patient is being singled out for some reason other than their conduct.

There are multiple resources available to assist providers in settings where patients exhibit disruptive conduct including resources that may help prevent recurrence. While charting is important, it does not trigger assistance in urgent/emergent situations (i.e., contacting Security).