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Largest EMTALA Settlement

Tips for Performing Ongoing Monitoring and Auditing

AnMed Health, a hospital located in South Carolina, recently agreed to pay $1.3 million for failing to provide appropriate screening examinations and stabilizing treatment to patients who presented to the emergency department with psychiatric conditions. This was reportedly the largest EMTALA settlement that also included a CIA. The OIG indicated that inasmuch as AnMed cooperated with the OIG during the investigation and engaged in significant corrective action, including expanding its psychiatric inpatient unit, a lower penalty would be applied.

Under EMTALA, hospital emergency departments must have appropriate medical screening examination capabilities to determine whether a patient has an emergency medical condition. If it is determined that a patient has an emergency medical condition, the hospital must provide further examination and treatment to stabilize the patient’s condition using the staff and facilities available at the hospital. Alternatively, if the hospital lacks such resources, it must appropriately transfer the patient to another hospital that can stabilize the patient’s condition. An “appropriate transfer” must comply with EMTALA’s transfer requirements which include, among other factors, that the receiving hospital has available space and qualified personnel to treat the patient, and has agreed to accept transfer of the patient and to provide appropriate medical treatment.

CMS has increased scrutiny of acute care hospitals, specifically those addressing mental health patients in emergency departments. CMS has found (1) inadequate medical screening examination (MSE) for mental health; (2) failure of the MSE to be ongoing, especially when the patient remained in the emergency department beyond shift changes; (3) mental health patients “holding” in emergency departments for extended time periods; (4) elopement of mental health patients from emergency departments; (5) the need for increased safety measures for suicidal and homicidal patients; (6) improper use of psychoactive medications as chemical restraints; and (7) inadequate documentation of MSE, psychiatric interventions, and justification for psychiatric interventions.

It is worth recalling that the OIG issued new regulations that increase the civil monetary penalty amounts for EMTALA violations and encourage providers to self-report EMTALA violations to CMS in order to potentially receive more lenient penalties where there is a violation of the law. The Policy Resource Center (PRC) has a detailed audit guide for EMTALA, as well as many related policies and procedures. The PRC provides the following suggested tips for compliance officers. For more information, contact the PRC directly.

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Tips for Compliance Officers

Compliance Officers should look for the following while conducting ongoing monitoring and auditing:

  1. EMTALA compliance includes psychiatric emergencies.
  2. The availability of inpatient psychiatric beds, which has decreased nationwide.
  3. Policies and procedures that specifically address EMTALA compliance.
  4. Specialists are on staff to meet the screening and stabilization requirements, as well as inpatient capabilities for stabilizing emergency patients.
  5. Staff members are not requesting payment prior to screening patients.
  6. Policies prohibit retaliation against whistleblowers that make reports.
  7. A method is available to internally report (e.g., hotline), address potential violations, and timely conduct investigations.
  8. The central log is properly maintained for disposition and compliance with legal requirements.
  9. The physician on-call list reflects coverage of services available to inpatients.
  10. Triage is performed properly.
  11. MSE and treatment are not delayed for registration.
  12. All physicians are presenting themselves to the facility when called and are in compliance with the timeframes set forth in the applicable policy.
  13. Audit transfer paperwork confirms that all transfers of individuals with non-stabilized emergency medical conditions are initiated either by (a) a written request for transfer, or (b) a physician certification regarding the medical necessity for the transfer (documentation must be included in the medical record and a copy sent to the receiving hospital).
  14. The facility has established a transfer request log to capture all necessary information.

Need Help with Ongoing Compliance Monitoring and Auditing?

Strategic Management Services has compliance experts with years of experience evaluating and auditing the effectiveness of compliance programs. If you have questions about getting your compliance program reviewed, give us a call at (703) 683-9600 or contact us online.

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