Understanding the Hierarchy of Laws and Rules: A Guide for Dentists and DSOs

Understanding the Hierarchy of Laws and Rules: A Guide for Dentists and DSOs

All laws are important. None is greater than another. For illustrative purposes we have here a funnel. At the top of the funnel are federal rules and laws (blue section). Next are state laws (and rules), which you will notice are at least as restrictive and are actually more restrictive than federal laws, which is not always the case. Then, there are county, city (local) laws and rules, which again are often more restrictive than state and federal laws. 

The bottom of this illustration is a blue ring that is representative of internal office or organizational policies that can be as restrictive (or more so) than the above rules and laws. Internal policies cannot, however, be less restrictive than local, state or federal laws or regulations. Additionally, policies cannot require violation of the law. In fact, they should always prohibit violating law or regulations.

Rules (regulations) are different from laws. Laws are created by state and federal legislators. Laws are generally either civil or criminal. Civil laws are punishable by fines and sanctions, while criminal laws are punishable by fines and confinement in a correctional facility. Examples of civil laws include business contracts, in-network provider contracts with insurance companies, and many OSHA and HIPAA regulations (though there are criminal provisions). Examples of criminal laws include drug diversion (i.e. forgery, writing prescriptions for non-dental purposes, theft of drugs, and can include drug abuse), and insurance fraud. Each of these is punishable by arrest, conviction and incarceration. 

Rules, on the other hand, are created by regulatory agencies. They often have the same effect as laws. Violations are punishable by fines and sanctions, which can include loss of licensure, but not incarceration. For example, most states have a Dental Practice Act (civil and criminal laws that define and limit the practice of dentistry). This is a set of laws established by state legislators that outline how dentists may attain a dental license, require they participate in continuing education, et cetera. Many state Dental Boards enact rules that often mirror the Dental Practice Act, but often they are very specific about many issues legislators do not have time or experience to address. Often those rules govern infection control practices, marketing practices, Standards of Care and establish administrative processes and function of the Board including disciplinary (sanctioning) standards. 

Following the funnel illustration from above – many organizations have standard operating guidelines or policies and procedures to establish operational guidelines, expectations and rules for the organization’s workforce. They are specific to the needs of the organization and must comply with city, county, state and federal laws. Violations of internal or organizational policies cannot result in fine or criminal conviction, but can result in disciplinary action including written warnings, remedial training, and suspension without pay, demotion, and termination of employment. 

Compliance with the multitude of laws and regulations dentists and DSOs have to contend with is no easy task. Today, the stigma of asking for help is a thing of the past. Every dentist and DSO should have a team of experts to help them understand and comply with the regulations that pertain to their organization. If you need a team of experts, well, I know a guy and he has a great team to help you navigate your regulatory conundrums. 


Written by Duane Tinker


Dental Compliance Specialists helps make dental offices safer for patients, dentists and their employees. We help our clients develop and maintain their compliance programs including OSHA/Infection Control, HIPAA, DEA regulations and prescribing practices, Radiation Safety, OIG/Medicaid Compliance, Record Auditing, and more by providing actionable systems, easy-to-use tools, robust training, and accountability. Most of our clients have never been in trouble and want to keep it that way. Sometimes, though, dentists call when they are in trouble. In either case, we are there to make a meaningful difference. If you need help call us at 817-755-0035.

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