Monitoring and Auditing Tips for Compliance Officers
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) identified the Emergency Medical Treatment and Active Labor Act (EMTALA) as a high-risk area in its previous compliance guidance. More recently, the OIG also referenced its EMTALA related enforcement actions in its Spring Semiannual Report to Congress for 2018. EMTALA is a statute designed to prevent “patient dumping,” a practice where hospitals fail to screen, treat, or appropriately transfer patients. The statute prohibits certain hospitals from denying emergency care to patients and promotes patient access to appropriate emergency medical services.
Hospitals must ensure the following, among other requirements:
- All patients who come to the hospital with an emergency medical condition (EMC) or in active labor must receive an appropriate medical screening examination;
- All patients with an EMC must be stabilized;
- All patients requiring or requesting a transfer must be transferred appropriately;
EMTALA violations may result in civil monetary penalties of not more than $50,000 (or not more than $25,000 for hospitals with less than 100 beds) for each violation. Most EMTALA cases continue to be resolved through settlement agreements with the OIG. These cases often involve an organization’s refusal to accept an appropriate transfer of patients to their emergency department (ED), or failure to provide adequate medical screening and stabilize patients.
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In the OIG’s Semiannual Report to Congress for Spring 2018, the OIG cited the following two EMTALA cases where the Civil Monetary Penalties Law was used to impose penalties:
- Cambridge Health Alliance (CHA)
- CHA paid $90,000 for its alleged failure to screen a patient after she presented on hospital property in medical distress. Specifically, the OIG alleged that a patient experiencing a severe asthma attack was unable to gain entry to the ambulance bay doors and collapsed on an adjacent bench. CHA was allegedly negligent in its search for the patient after the collapse occurred. This resulted in the patient’s admission to the hospital in grave condition and the patient’s death six days later.
- Piedmont Newton Hospital (PNH)
- PNH paid $52,414 for its alleged failure to provide an appropriate medical screening exam and stabilizing treatment to a patient. Additionally, PNH allegedly failed to appropriately transfer the patient to another hospital. The OIG alleged that the patient arrived complaining of chest and abdominal pain. PNH’s ED physician conducted blood tests and learned that the patient had undergone dilation and curettage two days earlier. The ED physician then ordered chest x-rays which indicated bowl perforation. The physician further consulted with the on-call surgeon who recommended transferring the patient back to the hospital where the patient underwent the dilation and curettage procedure. The patient arrived at the other hospital in septic shock and near respiratory collapse, and died later that day.
Tom Herrmann, JD, has over 20 years of experience in the Office of Counsel to the Inspector General, prior to becoming a compliance consultant. Mr. Herrmann has dealt with EMTALA issues on behalf of the OIG and for many of his clients. He advises that compliance officers should ensure that audits of patient transfer paperwork are routinely conducted. These audits can confirm that all transfers of individuals with un-stabilized EMCs are initiated either by a written request for transfer or physician certification regarding the medical necessity for the transfer, which must include documentation in the medical record and a copy sent to the receiving hospital. In addition, Mr. Herrmann notes that compliance officers should ensure the following:
- The hospital’s policies and procedures specifically address EMTALA compliance;
- Specialists are on staff to screen and stabilize emergency patients;
- Policies prohibit retaliation against whistleblowers;
- Staff members are not requesting payment prior to screening patients;
- A procedure exists to internally report and address potential violations;
- A central log is properly maintained for disposition, in compliance with legal requirements;
- The facility has established a transfer request log to capture necessary information;
- Physician on-call lists reflect coverage of services available to inpatients;
- A proper procedure for triaging exists and is being performed;
- Compliance includes psychiatric emergencies;
- Treatment is not delayed because of registration; and
- Physicians are presenting themselves in a timely manner.
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The experts at Strategic Management Services have over 25 years of experience in assessing and maintaining compliance program effectiveness. If you would like to speak to one of our consultants, you can call (703) 683-9600 or click here to contact us online.
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