September 1998

Health Care E-lert - Imagine opening the mail one day and seeing this ..., 9/11/98

2 min

Dear CEO: We have determined that you have violated the Emergency Medical Treatment and Labor Act (EMTALA). The deficiencies are so serious that they constitute an immediate threat to the health and safety of any individual who comes to the emergency department. We plan to terminate you from Medicare . . . . Sincerely, the Health Care Financing Administration

An increasing number of hospitals and physicians have gone through the wrenching experience of receiving such a letter from HCFA regarding alleged violations of EMTALA. Twenty-one hospitals and physicians recently paid over $710,000 from Oct. 1, 1997 through March 31, 1998 to settle patient dumping allegations with the Office of Inspector General (OIG). In Maryland, at least 10 hospitals have been cited for violations. HCFA recently cited a Chicago hospital for failing to provide emergency care to a gunshot victim outside the hospital. The OIG has announced plans for an even higher level of enforcement activities against hospitals and physicians. HCFA recently revised its Interpretive Guidelines and investigative procedures, effective July 14, 1998 to reflect significant changes in its enforcement approach and philosophy. Understanding the revised guidelines may assist hospitals and physicians in avoiding common EMTALA pitfalls such as:
  • confusing triage and the medical screening examination
  • requesting prior authorization for managed care patients, which EMTALA prohibits
  • delaying the MSE or treatment to inquire about insurance status
  • failure of on-call physicians to come to the Emergency Room to assist with the MSE
  • failure of a hospital with special capabilities to accept a transfer
  • the meaning of "stable for transfer" and "stable for discharge"
  • failure to transfer patients appropriately.
The surprise bombshell of the revised Guidelines is that off-campus hospital-owned facilities using the hospital's Medicare provider number, such as urgent care centers or satellite clinics, also must comply with EMTALA. This may be a significant problem for many hospitals. Please contact Connie Baker (410-244-7535, for HCFA's revised guidelines and investigative procedures, or to discuss an in-service presentation regarding EMTALA compliance. A presentation in Powerpoint '97 is available at Venable has offices in Maryland, Washington, D.C. and Virginia.