Emergency Medical Treatment and Labor Act

April 19, 2016 | Healthcare Risk, Quality, & Safety Guidance

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The federal Emergency Medical Treatment and Labor Act (EMTALA) (42 USC § 1395dd) was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). EMTALA is commonly referred to as the "anti-patient-dumping law" because it was passed in response to the practice of some hospitals to deny emergency care to indigent or uninsured individuals or to transfer them to other facilities primarily because of their inability to pay for medical care. Before the law was passed, an estimated 250,000 patients were denied emergency medical care or were transferred inappropriately to public healthcare facilities each year because of their inability to pay for medical services (Ansell and Schiff). Since EMTALA was passed, hospital emergency departments (EDs) have been prohibited from turning away people because of their insurance status or inability to pay; as a result, EDs have become a safety net for many individuals seeking medical care.

Changes in the regulations promulgated by the Centers for Medicare and Medicaid Services (CMS), CMS's interpretive guidance, and court opinions have shaped how EMTALA is applied. Federal courts have interpreted EMTALA's scope and requirements in a variety of factual contexts, sometimes yielding conflicting opinions among circuits. Today EMTALA's reach includes the hospital campus, certain off-site facilities such as hospital-owned urgent care centers, and hospitals with specialized capabilities or facilities, even if they do not have EDs.

In the first 10 years of EMTALA, the federal government collected $1.8 million in EMTALA fines against hospitals and doctors (Wanerman). As the public's use of EDs grew in the 1990s, Congress allocated funding for the U.S. Department of Health and Human Services (HHS) to investigate complaints and for the U.S. Department of Justice to enforce the law. For the three-year period from fiscal years 1998 through 2000, the federal government collected $5.7 million in fines against hospitals and doctors, nearly three times more than in the previous 10 years (Ballard et al.). After fiscal year 1999, when EMTALA fines reached a peak of $2.7 million, the amounts of EMTALA fines collected annually dropped significantly (see Table. Are EMTALA Fines Relatively Constant? for a tally of EMTALA fines levied against providers). As enforcement activity grew in the late 1990s, private causes of action escalated, and hospitals demanded ­relief from EMTALA obligations (Rosenbaum et al.). Now fines are relatively constant.

Every six months, HHS's OIG discloses penalties collected from hospitals and physicians during that period for violations of EMTALA. Total fines collected per fiscal year remained relatively constant over the 11-year period from 2003 to 2014, ranging from $206,250 to $715,000. The average citation during this period was also relatively constant at $37,300 (ranging from $13,750 to $61,000). ​ ​

Total Providers

(Average Citation)

Source: Office of Inspector General, U.S. Department of Health and Human Services. Civil monetary penalties and affirmative exclusions online. 2016 cited 2016 Mar 21. http://oig.hhs.gov/fraud/enforcement/cmp/cmp-ae.asp...

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