Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014

Abstract

We report the first national estimates of EMTALA enforcement activities in more than a decade. Although EMTALA investigations and citations were common at the hospital level, they were rare at the ED-visit level. CMS actively pursued EMTALA investigations and issued citations throughout the study period, with half of hospitals subject to EMTALA investigations and a quarter receiving a citation for EMTALA violation, although there was a declining trend in enforcement. Further investigation is needed to determine the effect of EMTALA on access to or quality of emergency care.

Civil Monetary Penalties Resulting From Violations of the Emergency Medical Treatment and Labor Act (EMTALA) Involving Psychiatric Emergencies, 2002 to 2018

“…Third, as published settlement descriptions varied considerably in length and detail across the study period, it is possible that some descriptions were sufficiently vague such that settlements related to psychiatric emergencies may not have been identified using our methods. However, in the vast majority of OIG settlement descriptions, the nature of the condition was indicated, and the proportion of settlements related to psychiatric emergencies (19%) was similar to the proportion of overall EMTALA citations involving psychiatric emergencies identified in our prior work (17%) …”

“…Centers for Medicare & Medicaid Services regional offices authorize EMTALA investigations, issue citations for violations, and determine whether a facility has an adequate corrective action plan to ensure future compliance so that a citation can be resolved. The ultimate consequence of failure to resolve an EMTALA citation is termination of the Medicare provider agreement, which almost universally results in hospital closure . This is not a theoretical risk; more than a quarter of U.S. hospitals were cited for EMTALA violations over the past decade, although most resolved citations without Medicare provider agreement termination .…”

“…The ultimate consequence of failure to resolve an EMTALA citation is termination of the Medicare provider agreement, which almost universally results in hospital closure . This is not a theoretical risk; more than a quarter of U.S. hospitals were cited for EMTALA violations over the past decade, although most resolved citations without Medicare provider agreement termination . Between 2005 and 2014, there were 355 citations for EMTALA violations related to psychiatric emergencies .…”

“…This is not a theoretical risk; more than a quarter of U.S. hospitals were cited for EMTALA violations over the past decade, although most resolved citations without Medicare provider agreement termination . Between 2005 and 2014, there were 355 citations for EMTALA violations related to psychiatric emergencies . Among 12 hospitals with Medicare provider agreements terminated for failure to comply with EMTALA, four cases (25%) involved EMTALA violations related to psychiatric emergencies .…”

“…Between 2005 and 2014, there were 355 citations for EMTALA violations related to psychiatric emergencies . Among 12 hospitals with Medicare provider agreements terminated for failure to comply with EMTALA, four cases (25%) involved EMTALA violations related to psychiatric emergencies . The Office of the Inspector General (OIG) of the Department of Health and Human Services receives information about EMTALA violations from CMS and may seek civil monetary penalties against hospitals or individual physicians that have violated EMTALA .…”