Since 1986, EMTALA has served as an important piece of legislation. However, several health systems have faced settlements to resolve allegations after OIG investigations revealed wrongdoing.
Access to emergency services
EMTALA was enacted by congress to ensure that the public has access to emergency services regardless of ability to pay. “Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay” (CMS Regulation & Guidance). While this piece of legislation has been in effect for over thirty years, healthcare organizations still struggle with compliance and commit violations. “On December 29, 2021, Tristar Centennial Medical Center (Tristar Centennial), Nashville, Tennessee, entered into a $725,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG’s investigation, Tristar Centennial violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide, with the staff and facilities available, further medical examination and treatment required to stabilize 29 patients’ emergency medical conditions” (OIG Article). As health systems try to navigate new healthcare compliance laws and regulations, it is vital that they do not lose sight of older legislation like EMTALA and continue to understand, implement, and adhere to those requirements.
Ongoing healthcare risk assessments
Healthcare compliance programs with emergency services should include this significant compliance risk in their ongoing risk assessment work. Best practice compliance programs assess operations to ensure appropriate understanding of this risk area and regulatory obligations, as well as assess to ensure that operations have sufficient internal controls such as policies and procedures, education and training of staff, and appropriate monitoring. Periodic auditing, in concert with the compliance risk profile and prioritization, should be performed to assess operations’ compliance with EMTALA. EMTALA audits should focus not only on the sufficiency of policies and procedures, education, and monitoring, but they should also include the visualization of appropriate signage, interviews of registration staff regarding check-in procedures and patient interface, and documentation of MSEs, etc. In addition to proactive risk assessments and audit work, compliance programs should be prepared to address reports of EMTALA violations, including potential investigations of non-compliance. In light of these considerations, compliance program staff should ensure that they stay educated and current on EMTALA regulations and industry standards pertaining to EMTALA management.
Takeaways
- Healthcare organizations need to be aware of the Emergency Medical Treatment & Labor Act (EMTALA) and ensure appropriate internal controls are in place for compliance.
- EMTALA risk should be included in both the compliance risk assessment and work plan, and the compliance program should be prepared to handle EMTALA reports and investigations.
- The OIG is still active in pursuing EMTALA violations, which could lead to large settlements.
- Internal monitoring and auditing should be performed regularly to mitigate risk of violations.
© Copyright 2022. The views expressed herein are those of the author(s) and not necessarily the views of Ankura Consulting Group, LLC., its management, its subsidiaries, its affiliates, or its other professionals. Ankura is not a law firm and cannot provide legal advice.
