Administration of the Law

Complaints of potential EMTALA violations are investigated by the CMS through its regional offices or state oversight agencies. Complaints related to physician issues are reviewed by peer physician reviewers from the state’s professional review organization.

If a hospital is found to be in violation of EMTALA and the CMS deter­mines that the violation poses immediate jeopardy to the health or safety of people who come to the ED, it is given a 23-day notice of termination from participation in federal insurance programs (Medicare, Medicaid, CHAMPUS [The Civilian Health and Medical Program of the Uniformed Services]). During that time, the hospital is to develop, present, and have approved a program to ensure compliance.

The Health and Human Services Office of Inspector General reviews all cases and may levy civil monetary penalties for violations and prosecute cases that are disputed. Hospitals with fewer than 100 licensed beds can be fined up to $25 000 per violation incident. Larger hospitals face fines of up to $50 000 per violation. Physicians found in violation can be fined up to $50 000 per patient violation incident in addition to termination from par­ticipation in federal insurance programs. The law also grants patients and aggrieved medical facilities the right to sue for damages for injuries sustained as a result of an EMTALA violation.

Summary

EMTALA is a complex law that has particular application to air and ground transport of neonatal and pediatric patients. Furthermore, the CMS is often updating their interpretation of the law. To date, more than 2000 facilities have received EMTALA enforcement actions from the CMS. It is important that all providers are appropriately educated and trained about EMTALA and that transport organizations have appropriate policies in place. Additionally, a proactive relationship with risk management and legal counsel will help ensure continued compliance.