Welcome, everyone, to the webinar on How to Avoid the Top Ethics Pitfalls for Hearing Healthcare Professionals. We are very glad you could be here today with us to learn more about how to resolve the most common ethics issues you'll encounter with integrity and professionalism. Your moderators for today are me, Fran Vinson, IHS Marketing Manager. And me, Carrie Peterson, IHS Education Administrator. Our expert presenter today is Chris Gustafson, ACA, BC HIS, and IHS Past President. Chris is the owner of Evergreen Hearing Center in McMinnville, Oregon, and has long remained an active member of the hearing healthcare community. He has served as a board member and past president of the Oregon Hearing Society and is a former member of the Board of Directors for the National Board for Certification in Hearing Instrument Sciences. Additionally, Chris was also on the Governor's Advisory Council on Hearing Aids for the Oregon Health Licensing Agency. He's also a graduate of the IHS American Conference of Audioprosthology Program. He holds an Associates of Applied Sciences from Spokane Falls Community College and a Bachelor of Science in Psychology from Western Oregon University. We're very excited to have Chris as our presenter today, but before we get started, we have a disclaimer to review and a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on demand through the IHS website in the future. While this presentation highlights recognized principles commonly found in the legal arena, it in no way connotes nor should be considered legal advice. Please consult with your legal counsel for specific advice regarding legal matters that may be pertinent to you. This webinar is available for one continuing education credit through the International Hearing Society. You can find out more about receiving continuing education credit at our website at IHSinfo.org. Click on the webinar banner on the homepage or choose webinars from the professional development menu on the left side of the page. There you'll find the CE quiz and information on how to submit it to IHS for credit. Also on the webinar page at the IHS site you'll find a note taking guide to help you gather the information you'll need for the CE quiz. If you haven't already downloaded it, feel free to do so now. Tomorrow you will receive an email with a link to a survey on this webinar. It is brief and your feedback is essential in helping us create valuable content for you moving forward. Today we'll be covering the following topics along with a Q&A within a 60-minute presentation. Ethics Defined, Professional Ethics, Marketing, Business Ethics, and Ethical Conduct. At the end we'll move on to a Q&A session. You can send us a question for Chris at any time by entering your question in the question box on your webinar dashboard, usually located to the right of your webinar screen. We will take as many as we can in the time we have available. Now I'm going to turn it over to Chris who will guide you through today's presentation. Chris? Welcome to the presentation on ethics. We're going to start out with ethics defined. So the definition of what is ethics. Ethics is something that you can't legislate. However, ethics drives legislation. If everyone were to behave in an ethical and moral manner, there would be no need for legislation. There would be no laws. So what is ethics? Webster defines ethics as the discipline of dealing with what is good and bad and with moral duty and obligation. It's a set of moral principles or value. A theory or system of moral values. Ethics is the principles of conduct governing an individual or a group. Ethics is conforming to an accepted and especially professional standards of conduct. Morals are conforming to a standard of right behavior. They are a set of moral principles or values. A theory or system of moral values. And the principles of conduct governing an individual or a group. It's relating to the principles of right or wrong. Ethical ethics are those which are ingrained due to education, experiences, or upbringing, societal and familial expectations. It has considerable influence upon other ethical considerations, even those beyond and more influential than the person himself or herself. Professional ethics are the professional codes of ethics and are the rules and principles that govern the behavior of the members of the profession. Personal or professional ethics are based on the morals and values of the professional members and are a statement of the principles that patients and other professionals would expect us to uphold. Professional ethics are founded in public policy. They are a standard of practice or a code of conduct. They are systems of codes or morals. And our license and certification does mean something. So we're going to begin with discussion of professional ethics. In discussing this, we will discuss both what is professional ethical and what is unethical. So starting out with professional ethics, misrepresentation falls under the unethical category. This is words or conduct by one person or another amounting to an assertion and not according to true fact. These statements are substantive or material fact with the intent to deceive or mislead. Within our practices, within our businesses, misrepresentation falls into play in our selling of the products and services that we provide to our patients. This could be mid-level for high-end, a used instrument as a reconditioned instrument, a reconditioned instrument as a new instrument, or a demo for a new instrument. Now where I've seen this come into play is an individual took an instrument that had been reported lost to the manufacturer and sold it as a new instrument. When the patient called the manufacturer to ask about their warranty status, they were informed that this was not a new instrument, that it had been reported as lost. A complaint was filed to the state and ultimately that dispenser ended up losing his license. So misrepresentation, selling a product that isn't, be careful with that. Be honest in what you're handling, what you're dealing with, and how you're representing it to the patient. Falsifying records is another area that's come up on the radar screens time and again. This is in purchase agreements and or in our test results, the audiograms, and reporting to insurance companies. Now a case that comes to mind here is an individual came in and said, my insurance doesn't kick in until the first of the year, this being in late November, early December. Can we postdate the test results and the purchase agreement so that it is covered by the insurance company? The answer on that was no. The individual waited and we did it legally and did not have any falsification of records or test results as a result of that. Another area that gets us into trouble, failure to refer to a physician when an FDA red flag is present. I have sat in on numerous meetings over the years where a group of dispensers and even audiologists are discussing the FDA red flags only to sit down and have them list out what are the red flags. And they will get six or seven, but rarely do they get all eight of the red flags. So this is something that should be so well ingrained into our memory banks that we don't have to stop and think about it. We should be able to readily read them off or recite them off without having them printed out before us. It is so important that I'm going to cover them here today. While there is a visible, congenital, or traumatic deformity of the ear, active drainage from the ear within the past 90 days, sudden loss within the past 90 days, a unilateral hearing loss, an ear bone gap greater than 15 dB at 5'1 and 2", reported acute or chronic dizziness, the reported pain or discomfort in the ears, excessive cerumen or foreign body in the ear. I can't imagine how embarrassing it would be if a doctor had called up or sent over a fax saying, hey, send us a copy of the test result, only to see that, oops, there was a greater than 15 dB ear bone gap and that person should have been referred to the physician before fitting them with a hearing aid. It would be a little embarrassing and in violation of the FDA. So be careful on this. My recommendation is sit down and memorize these eight warning signs. They come into play and they're important. The next issue that I'd like to discuss is theft of services. A story that comes to mind was years ago I heard a dispenser bragging how he had sold a set of hearing aids to this lady who didn't have the money to pay for the hearing aids. So in trade, he ended up taking a diamond ring, a microwave oven, and a piece of artwork, plus enough money that covered the cost of the hearing aids. So who was hurt here? Trading goods or property for your services rather than money, it hurts yourself. It's unethical. It is illegal. And what the dispenser avoided was paying taxes on the profit that he made. He took an unfair advantage. Now this comes into play on several issues. Perhaps there was another dispenser within the community who would have been glad to fit that lady and help her out with financing or find a product that was within her budgetary means without taking her goods, her property. It was certainly unfair to the patient. Continuing on theft of services, the selling of a product or service on your own when you're employed to do the same for an employer without the employer's authorization to do so. Now a story came to mind when I was preparing this presentation of a dispenser sometime back had taken in a set of used hearing aids as trade. The owner of the business was well aware that these instruments had taken in on trade and authorized that, but this dispenser took it upon himself to turn around and sell that product as a new product to another customer. When the customer was not satisfied with the service that she was getting, she called the main office. What happened as a result of this, this person had legal charges filed against him and ultimately ended up losing his license as a result of that. It's not worth it. If you're fitting a friend or a relative, get the authorization from the boss to say, hey, it's okay. You're going to get it, but don't steal it. Don't take it. Another issue that's come up on the radar screens over the years is taking a copy of the database when you lease the employment of the business. That is property of the business. Not an individual's, even though you may have fit the person's. That is property of the company. It's not only illegal in the local jurisdiction, but now with federal laws, it's also a violation of the HIPAA regulations. Professional ethics require that we perform accurate and complete test results. There are no shortcuts. It is truly your reputation that's at stake. Again, I can't imagine how embarrassing it would be if a doctor sent off a patient with a request to send me a copy of the test results. And that test result is inaccurate, incomplete, something left out of it. If it is listed as a screening only, that's fine. Indicate so. But do the tests, do them right. Make sure they are accurate and complete. Professional ethics would prohibit us from using an official or elective position in any organization for self-advertisement. That would be like certifying that you are a professional. That would be a violation of the HIPAA regulations. That would be like serving on the state or provincial board for the Hearing Society, serving as an officer or a board member of the local, again, the local or international Hearing Society, the licensing boards. It could be serving as an officer or a board member of a local service club. We don't take on those positions to brag about ourselves saying, oh, look at this, I am so good, I am the president of this organization. We do it because we feel that we can be a benefit to the organization and the people that the organization serves, not for bragging purposes. In fact, with the state of Oregon, they have you sign a disclaimer In fact, with the state of Oregon, they have you sign a disclaimer saying that you will not do so while you are serving in that capacity. After the fact, when you are no longer a board member or an officer of an organization, you can say that you served on it, but while you are serving, don't advertise it. And it's unethical to use such terms or any abbreviation of such terms as doctor, physician, otologist, board certified in hearing instrument sciences, audioprosthologist, clinical audiologist, medical audiologist, research audiologist, industrial audiologist, or any other title or abbreviation when such is not the fact. And when holding a master's or a doctorate degree in another profession, something other than hearing sciences, delineation of such credential is not allowed. Delineation of such credential shall be required. Now, in my case, as the introduction said, I've got a bachelor's of science degree in psychology. If I want to list my name as Chris Gustafson B.S., I have to list it as Chris Gustafson B.S., psychology. Otherwise, the patient or other professionals will look at that and say, oh, he must have a bachelor's in speech and hearing sciences. In my case, I've had people come up who have master's degrees. One that comes to mind is counseling. Can I list it? Yes, you can list it, but you have to have MA in counseling, not just MA. Otherwise, they're going to assume that you've got your master's in audiology. So show what your professional credentials are. Keep it accurate. Keep the confusion out of the question there. Now, using the term MBA doesn't really require any additional. You don't have to list it as master's in business administration. MBA stands exactly for that. So that one would be okay. Again, B.S. in psychology, that would be required. And within the profession, individuals cannot charge for services that are not rendered. Again, both unethical and illegal. In billing a third party, insurance companies, or charging the patient, it comes down to a number of factors. It comes under the False Claims Act. And again, that is for those in the U.S. and if we've got attendees today coming in from Canada, the rules and laws in Canada may be a little bit different. But in the U.S., it comes under the False Claims Act. Submitting false claims to a federally funded program for reimbursement. This could be Medicaid, the state-funded welfare programs, or other insurance companies. Oftentimes, the other insurance companies are tied in with the federal government. There is no intent to deceive that's required. If it happens, this could be a very costly mistake. So be careful. What you're submitting, make it accurate, make it honest. And to participate in other health professions with other health professionals or any other person in agreements to divide fees or cause financial or other exploitation when rendering your professional services is unethical and illegal. Where that would come in within our profession would be making an agreement with a doctor for him to refer patients to you and if the patient ends up buying a product, you're turning around and giving him some sort of remuneration. I'll give you a $50, I'll give you $100 for every patient you send them by. This is illegal, not only for us, but for the doctors. So don't even tempt them. It just isn't worth the trouble that it's going to cause. Beat and switch is another issue that comes up from time to time. Advertising shall offer only the merchandise for services that are readily available for purchase during the advertised period at the advertised price. Frequently I will see price advertising, and it's not uncommon for me to make a phone call to a customer and say, how many of these instruments are you really fitting at that price? And surprisingly, yeah, if that's the market that you want to attract, that's fine, but if you don't have the product or you're trying to get them in the door so that you can sell something that is a better quality, higher price, you have to have that first product available or it is beat and switch. It's unethical to advertise a particular model or kind of instrument to obtain products for the sale of a different model or kind of instrument that is advertised, or to imply a relationship with a manufacturer and trade names that do not exist. Delays in delivery. The product should be made available as soon as reasonably possible. I've seen this, you know, oh, I'm tired, I'm tired, I'm tired, You know, oh, I'm tired today, I don't want to do this. That patient oftentimes is taking considerable time and thought, which led them to your door. Your schedule may be busy. It may require you to work longer hours to be able to take care of that patient and get that product delivered to them as soon as it's reasonably possible. Failure to keep or schedule follow-up appointments is another one that has gotten dispensers into trouble. There was a case that comes to mind of a dispenser years ago who did a lot of house calls, did a lot of traveling, had a remote clinic that they were working halfway across the state. The dispenser, unfortunately, the dispenser, unfortunately, scheduled his visits about once a month. And if he had a fitting that he was uncomfortable with, he would stretch that out after the fitting so that his follow-up appointment was five, six weeks out. And if the patient said, you know, I really don't like this hearing aid, I want to cancel it and send it back, he would inform them, I'm sorry, but your 30-day trial has expired. I can't take it back. The manufacturer won't take it back. Not only is it not true he was lying to the patient, but it ended up in a change in the state laws here in Oregon that required that within the 30-day trial period, you had to have at least one follow-up visit, you had to schedule it, or the 30-day trial went on until that visit was made. So not only did he get in trouble, but it changed the laws for the rest of us, and I think it was a good change. It was used to avoid cancellations, but whatever the reason, avoid the delay, take care of the patient, provide the follow-up, provide the service. Now the next issue that I'd like to discuss is in marketing. Truth in advertising, we've all heard the phrase before, but state only the true facts in public announcements and in your advertising of hearing instruments and related products, and in no way mislead or misrepresent in regard to their performance, appearance, benefits, elements, and the use. As business owners, we're all confronted with the yellow pages. Some of them come through on the Internet, through facts, through representatives of the yellow page companies coming to us, and every year we have to sign off as a business owner saying, I approve of this ad. So do not knowingly place an ad in the yellow pages under your audiology when you are not an audiologist or have one employed within your business. I've seen more businesses getting in trouble from the audiology board. You're going to have a letter of complaint. You're going to have a cease and desist. You may have civil or financial penalties thrown at you. You may be taken to court on this. Don't do it. If you're not an audiologist, you don't have one working for you, stay out of that category. Keep it under hearing aids and hearing tests, whatever, but not under audiology. The next issue that's come up is a discussion about free hearing tests or valuations versus free screening. You cannot charge one person for the test if you don't charge another one for the exact same test. Now I'm talking specifically Medicare, Medicaid, which is the state funded welfare programs, and insurance companies. Now if you're not billing insurance companies for your services, you can do whatever you want. You can provide free hearing tests, free hearing evaluations, free audiometric evaluations, free screenings. It doesn't make any difference. It's not unethical to do that. But if you're charging the insurance companies, don't advertise the free hearing tests. You're going to get yourself into trouble. This is insurance fraud. Advertise it as a free screening and train your staff answering the phone. Does your business provide free hearing tests? If you're billing an insurance company, have them say, we provide free screenings. Keep yourself out of trouble. Be careful how you advertise. That's both verbally, in the newspaper, your flyers, your mailers, however you're advertising. Again if you're testing and billing the insurance companies, advertise it as free screening. Now let's look at business ethics. Maintain the confidentiality of the information and records of those receiving your services. All laws and rules and regulations pertaining to keeping records must be carefully observed. How embarrassing would it be to have a customer complain that they saw records of someone else. In fact, I had a situation came up here about a year ago. A young gal came in and bought hearing aids from me. We did the delivery, and in the interim period, her father had come in, and he ordered hearing aids. And he turns to me and says, well, I understand my daughter was in here getting hearing aids. I just said, yes, I've met your daughter. Well, on the follow-up visit, the daughter came in and says, I understand my father was in getting hearing aids. I said, yes, I've met your father. She says, I don't appreciate you discussing my hearing loss with him. I said, well, wait a minute. Did you tell him that you'd been in here? She said, yes. I said, that's how he found out? I just noted or made a comment that yes, we had met, and that's all I said to him. I did not discuss your hearing loss. I did not discuss what you bought. That is your business, not his, unless he comes in with you and you give him permission to come in the back room. It was not discussed. She says, oh, okay, I thought you'd told him. And I said, you told him. I didn't. So be careful with this. We have to follow the rules, the laws, and the laws are HIPAA. That's federal again. You don't want a complaint being filed to them and have them come around saying, what's going on here? Keep the welfare of the patient uppermost at all times. Now, this issue came up in a discussion not too long ago about fitting instruments based on the promos. Yeah, I was offered to buy six packs of these hearing aids. I'm having trouble getting rid of them. Don't fit them if it's not in the best interest of the patient. Fit only what's good for the patient. Fit them with the best technology to meet their needs, their lifestyles, and their financial abilities. And this is where your intake form, your patient history, and your questioning and discussion with the patient beforehand gives you the information you need to help guide you in making the decision as far as what technology, what product is going to be best for them. But don't fit a hearing aid on a person that's not right for them just because you've got an inventory and want to get rid of it. It'll come back and be a problem for you. You don't want it. Again, business ethics, it would be unethical for not refunding the money on a canceled sale within the time frame required by law. There have been so many people that I know in the profession that have gotten in trouble over this. It is my recommendation that every business owner should maintain a line of credits sufficient to cover the unexpected costs of running the business, and that definitely includes refunding the money on a canceled sale. It's doing the job right. Taking care of the patient as if they were your parent, your spouse, or relative. And if you take care of your patients, they will certainly take care of you. Look beyond the end of the day. If a transaction has been canceled, have the patient leave as a friend. Not disgruntled because you charged what is in their mind to be an exorbitant trial fee that is unexplained for something they did not get. Now, a trial fee oftentimes is written in either state statute or the rules and regulations guiding how we operate within the profession, within the state. It's legal. It's ethical. On a side note, my personal feeling is that if a patient cancels a transaction, they came in, they took time and consideration, thought, worry, frustration, anger, fear, all the emotions that the patient goes through to get to your door so that you can solve their problem. And if they end up canceling the sale, then I failed. I have not provided what I said I would provide. And as a result of that, I do not charge a trial fee. That's my personal feeling. It's not that it's ethical or unethical. That's just my decision. But I would much rather have that person leave as a friend, knowing that when the time was right for them, they would come back to me and try again, rather than going to a competitor or another dispenser, either within the same town or the next town over. So do what you feel is right. But if you're going to charge a trial fee, make sure that the patient is well aware what is covered and that the trial fee is in place and that it's discussed with them before they leave and sign the purchase agreement to begin with. Avoid disparaging, pejorative, and inaccurate remarks or comments about professional colleagues or members of the hearing health care profession. Respect yourself at all times in a manner which will enhance the status of the profession. You know, if you have a patient come in who says, I tried hearing aids at the office wherever, the next town or down the street, whatever, and that dispenser I was really unhappy with, don't downplay that. Don't even go there. If you're going to complain or take their complaint and build upon it and say, well, yeah, that guy's just got a bad reputation or whatever, you're only hurting yourself. That patient's going to look at you and say, well, what am I getting into here? What kind of a person is this? Build up the profession. Don't tear down someone else. Be supportive to individuals and organizations with whom you are associated with to their mutual benefit. And do not agree to practice under terms or conditions which tend to interfere with or impair the proper exercise of your professional judgment and skill. Practice which tends to cause a deterioration in the quality of your service or which require you to consent to unethical conduct. Now, there's some other considerations that we need to take into consideration here. I mean, these issues will come up, and I feel it's important enough to put it into an ethical discussion. The first one is elder abuse or child abuse. Now, this could be for somebody who is disabled or abled. As an allied health profession, many states and provinces require that you report the abuse to the authority. This could be physical abuse, it could be mental abuse, it could be verbal abuse, any of these. Now, years ago, I had a lady come to me, been a long-time customer. She reaches into her purse and pulls out a safety deposit key and says, can I have you put this in an envelope and store it in my file? And I looked at her and I said, what is going on? Why do we need to do that? Now, this was probably 25, 30 years ago. Before the abuse reporting laws were put into effect, she says, well, I've got relatives I don't trust and they're stealing from me, and I don't want them to find my bank deposit key. And I said, this sounds serious, should we call the authorities? And she implored me, please, please, please, don't call the authorities, let me take care of it. I put the key in an envelope, taped it inside her file, and put it away. It was three or four months later that she came back in for another follow-up visit and says, oh, by the way, I've taken care of my problems, can I have my key back? At which point I had the file out and I opened the envelope and gave her back her key. But if it happens, and it does happen, if you see it, if you suspect it, call the authorities. The call can be anonymous, but we're required to make that call and it's going to help that patient out. Another area that's on the screen frequently is patients with Alzheimer's or dementia. Now, here a story comes to mind that there was a dispenser who had time and time again gone out at the patient's request to sell a set of hearing aids. He would take a down payment, go back, write up the order, send the impressions in, only to have the transaction canceled by some member of the family. Well, it finally came out that one more time he did the same thing. He goes out, the sales cancel, he says, this time I'm going to take that money and I'm going to keep it as a trial fee. They complained to the state, the state said, no, you've got to refund it, you're beyond the 10-day trial or the time to refund, therefore, we're charging you civil fines, and he's like, can they do that? I said, yeah. How many times does it take you to go out to find out that the lady's got dementia, that she's not in control, and that the family members have to be brought in? He had to refund the money and he had the charges with the agency to straighten out as a result of that, but don't make the mistake. If you've got a patient, you've got to take care of the patient first, but you have to bring the family and care providers into the picture. Now, I would be remiss if I didn't bring up the Stark Laws, and it really doesn't have a great deal for our membership, but the Stark Laws prohibits physicians and their immediate family members from referring patients for designated health services to any entity which the physician and his immediate family members have a financial relationship. Now, the doctors are going to be aware of this, but there are certain exceptions that do apply, so be careful with this, and like I said, it really doesn't have a great impact on us, but there are members of our society, members of our profession, who have doctors in the family, so I need to bring that up. In going through and preparing this webinar for you today, I've used the Webster's Dictionary, the IHS Code of Ethics, AAA Code of Ethics, and Douglas's presentation from last year in putting this together. I would like to say thank you to the International Hearing Society for allowing me the time to share with you my opinions, my thoughts, and the information on ethics and morals, and I hope that this has been a benefit for you. If you have questions, please enter them in on the question box on your webinar dashboard. We'll be happy to answer them with as much time that we have available. Thank you, Chris. Everyone, this is Fran, and thank you, Chris, for your kind words. So everyone, we're really excited that more than 100 of you joined us today on the webinar. We do have time for questions, so if you have a question, as Chris said, please enter it in the question box on your webinar dashboard. Our first question is from Julie in Florida, and she wants to know, if you're working a doctor referral program, is it ethical to drop off, you know, donuts, snacks, cupcakes, that kind of fun stuff to the doctor's office staff, or is that a conflict? No. It would be ethical. You know, the doctors have their codes of ethics and their rules that they have to follow, and a box of cookies or a box of donuts or even sandwiches and sodas, taking it to the doctor's office for a lunch and learn is going to fall well below what is ethical for them to receive. And if it's helping you to make aware to the doctor's office and the doctor your presence within the community to take care of his patients as they are being referred to you, there's certainly nothing unethical about that. So go right ahead and hope you have a good relationship that is an ongoing relationship for you. Chris, we had a few people ask about developing a doctor referral program and how to present yourself ethically and professionally when doing that. Do you have any tips for them? The first recommendation that I would have is any time that you're going to a doctor's office, first of all, dress professionally. If you have a scheduled appointment time, be prompt. Be a little bit early. It doesn't hurt to have to sit in the waiting room as the doctor has the time to squeeze you into his busy schedule. And if you're doing any reports back to the doctor, whether it's at the request of the doctor or at the request of the patient, be prompt in getting those reports written up and sent over to the doctor's office. They're going to appreciate that, and it shows your level of professionalism and dedication. So be prompt. Be professional. Great. Thank you, Chris. So we have a question from George in New York, and he wants to know, and actually this is also on the CE quiz, everyone, so if you're paying attention for that, you'll want to note this particular question and answer. If someone's advertising a special, like a two-for-one or dollar amount off for their special event, do they need to provide the same level of warranty or services that they would usually provide if the product was sold at a normal price? Why or why not? And what other considerations or notices do they need to provide? Well, first of all, if you just list a product at half price or two-for-one or whatever the dollar discount is, and that's all you're advertising, then yes, you should ethically provide the same service, the same warranty, the same as what you would normally provide. Now, if you list a product at this discounted price and you put into the advertisement, this sale price includes a one-year warranty instead of your usual two or three or whatever you provide, two packs of batteries instead of more or whatever, or just the product, the warranty period on this product is one year, service for one year, you may normally provide lifetime service on the instrument. List what you're advertising. List what the sale involves and you're not going to get yourself in trouble. That would be the ethical way to handle that. Thanks, Chris. We have a couple of people ask this actually. It's regarding the HIPAA laws. If you're giving a free test or a free screening, free audiogram, et cetera, A, how do you keep records if the patient requests them in the sense that are you obligated to give the test to them if it was free and can you charge for it? How does that impact if the patient wants to take that test and take it someplace else and buy their hearing aids? Well, of course, we all hate to see that and I'm sure it happens and we've all run into that. The copy of their hearing test results is truly their health information and they are entitled to that. Now, if you're advertising a free test or a free screening, you can charge a reasonable fee for the copy. Now, reasonable fee, I'm saying $5 or $10, but to sit down and say, well, yeah, you can have a copy of that test but it's going to cost you $100 knowing that they're going somewhere else to buy the hearing aid. That's not free. A reasonable cost would be a $5 or $10 copy fee. If you're doing that, I would post a sign in the office in the waiting room that test result copies will be made available for a copy fee of whatever you're charging, $5, $10, but keep it reasonable and stay ethical with that. But to sit down and say, oh, yeah, you can have a copy of that test but it's going to cost you $100, that's no longer a free test and they do deserve the copy of that test. That's theirs. Okay. Great, Chris. Is it unethical, and this question comes from Mark, is it unethical to advertise free hearing evaluations for limited days only so long as you refrain from billing insurance for those particular services performed on those particular days? Again, if you're billing insurance, I would stay away from advertising any free hearing tests. Advertise it as a free screening and provide it as, okay, free screenings on these days. And if you're billing insurance and you're not charging some and you're stepping into a case of insurance fraud and you can get yourself in trouble from that, I would stay away from advertising free hearing tests, free hearing evaluations if you're billing insurance companies. Otherwise, give it to the insurance companies at no charge. Okay, good. That would be the quick and easy way of taking care of that, certainly. Yes, very good. Fair enough, Chris. All right. Daniel wants to know, is it okay to have a patient referral program that rewards patients monetarily when they refer a friend? That's a tough one. If it's a patient that's doing it, I would say no. I've seen many dispensers have programs where if a patient refers, perhaps they're getting a free repair or perhaps it's free batteries or maybe it's a gift card that's got a dollar value of $25 or $50 on it for the referral. That's not something that is going to be unethical or illegal. Where we can't do that is with the doctor's office. That comes in as fee splitting, but with a patient, say, or getting a discount on their next set of hearing aids, it's a way of saying thank you. It's paying for the advertising one way or another. I guess that would fall under the it's ethical. It's not going to get you into trouble legally. It's your call. Okay. Thanks, Chris. We have a question from Dwayne who has a predicament. He says that, and I'm sure it's probably true, that there are a lot of web directories out there that don't have anything other than audiology to advertise yourself in, meaning there's not a hearing aid services or hearing aid dealer or other hearing tests or anything else like that. So he wants to know, in that case, if there's no other alternative, is it okay to be listed under audiology in a web directory because that directory doesn't have any other categories for hearing aid specialists, hearing aid centers, etc.? What are your thoughts on that? I would have to see why they don't have something listed under hearing aids and hearing services, but if audiology is the only location, advertise there, but do so with the local audiology community being fully aware of it, and make sure that you are listed as a hearing instrument specialist, not as an audiologist, and be careful with that. Otherwise, it's misleading the public, and the audiology group is going to be all over that saying, hey, wait a minute, you can't do that. Now, again, list yourself as a hearing aid specialist, not an audiologist, if that's the only means of advertising that you have, but I would be looking into why are there not advertising categories under hearing, hearing aids, hearing testing, hearing aid repairs, whatever category that we would normally advertise under, why aren't they available? I would be demanding availability under those categories. Okay, thank you, Chris. Gloria has a question about working with physicians, and her question, she wants to know, is it ethical to send physicians a referral notepad to write a referral for hearing aids with medical clearance directly to her and her hearing health care practice, and has their contact information, etc., etc.? Is that ethical? I know I've seen that at doctor's offices for a variety of different types of providers, from physical therapists to laboratories, MRI centers, etc. How is that treated for hearing health care professionals, is that ethical? Absolutely ethical. In fact, the Better Hearing Institute, in their program here a number of years ago, with their physician referral kit that they had, had referral pads just like that, sent out to us as dispensers to take to the doctor's offices. The doctor has a choice of saying, yes, I'm going to use that as a source for taking care of my patients, and I'm going to send that patient to the business, they have the choice of sending it to you or someone else, and if you put that pad in there, it's no different than putting your business cards in their office form. So absolutely that is ethical. Good luck with the program. Thank you, Chris. We have a question from Carla, and she says she's renting space inside a doctor's office, and the doctors do refer to her regularly, but she does not pay them for these referrals. I think I know the answer to this, but if you would, to let her know what you think about it. If you think, is that something she needs to pay them back for, or, we'll just go back to what you said about not dividing fees or anything like that, what are your thoughts? That could be construed as fee splitting. Now if you're paying rent, that's one thing, that you're buying the space, you're renting the space from the doctor's office. They are referring patients to you. If you gave them money back for that per referral or per sale, that would be fee splitting, so you can't do that. So stay away from that one. Okay, thanks, Chris. Kelly wants to know, when manufacturer warranty dates are different than contract dates sold, which is more ethical to follow? Okay, repeat that again, to make sure that I'm getting this right for you. Sure. Okay, Kelly says, when manufacturer warranty dates are different than the contract dates sold, which is more ethical to follow? You know, we run into that here in the office as well, that we may write up a purchase agreement or a delivery receipt that has a warranty date that is, most of our warranties are three years, so three years from the date of purchase. The actual warranty date may actually be a little bit longer than that from the manufacturer. We will go back and correct that and note that in the file that the actual warranty date expires with the manufacturer, not on what we had written in initially. So go with the longer one. You know, if the patient goes somewhere else and your warranty date says it ended on the end of the month of February, and the manufacturer's warranty says it ended on the end of March or the middle of March, and their warranty is about to expire and they think that it's expired, and they go somewhere else and say, oh, no, your warranty is in effect, you've still got another two weeks, three weeks, that's not going to look good for you. So do the ethical thing. If the manufacturer's warranty is longer, go with that. If the manufacturer's warranty is less, then say it's an instrument that you've had on the shelf, a stock instrument, either have the manufacturer reset the warranty date or you're extending the warranty date on your own bill, and if the warranty is expired when they need a repair, then it's going to be your call. You're going to have to pay for that repair because you've stated that the warranty was out to that point where the warranty expired. So do the right thing. I would go with the longer warranty to make sure that the patient is taken care of. That sounds good, Chris. Thank you. Well, everyone, we're getting down to the end here, and we thank everyone for submitting questions. I think, Chris, it's impressed upon me how ethical and unethical behavior really not only affects a person's business, but really affects the whole profession. And so looking at these ethical practices, I think when you run your business and work in a very ethical manner, you build credibility amongst your patients, their families, and your community at large. So any last thoughts or anything on that, Chris? You know, it comes back down to what was told to me many, many years ago by an old-timer in the business. Take care of the patient, and they'll take care of you. You know, it's come to my attention that the greatest cost which might lead one to do something unethical is truly a financial situation. And as I said earlier, if you have a line of credit that protects you and the business from the fluctuations, the cash flow, you're not going to be tempted to do something that's unethical. Take care of the patient. So I appreciate everybody's attendance today, and I appreciate what IHS has done in helping me to prepare this and present it to you guys. So do have a good day. Thank you, Chris, for an excellent presentation. It was great working with you as well. We thank everyone for joining us today on the IHS webinar, How to Avoid the Top Ethics Pitfalls for Hearing Health Care Professionals. If you'd like to get in contact with Chris, you may email him directly at IHSGUS at gmail.com. For more information about receiving a continuing education credit for this webinar, visit the IHS website at IHSinfo.org. Click on the webinar banner or find more info on the webinar tab under Professional Development. IHS members receive a substantial discount on CE credits, so if you're not already an IHS member, you can find out more info at IHSinfo.org. Please keep an eye out for the feedback survey you'll receive tomorrow via email. We ask that you take a moment to answer a few brief questions about the quality of today's presentation. Thank you again, everyone, for being with us today, and we will see you at the next IHS webinar.

webinar

ethics pitfalls

hearing healthcare profession

Fran Vinson

Carrie Peterson

Chris Gustafson

professional ethics

unethical behavior

patient confidentiality

ethical challenges