EMTALA Update 2019
The Most Cited Deficiencies by CMS for Hospitals

Friday, November 22, 2019

AXIS Medical Education designates this continuing nursing education activity for 7.5 contact hours.

EMTALA is a hot topic and should now be on the radar screen for every hospital. There have been a recent increased number of deficiencies and increased CMS and OIG activity. Would you know what to do if a CMS surveyor walked into your hospital today to investigate an EMTALA complaint? Most hospitals were unprepared. Did you know that the EMTALA penalties have more than doubled plus a cost of living so it is almost $105,000 per violation for hospitals over 100 beds? A recent article found that 30% of US hospitals have violated EMTALA in the last decade. Violations were most likely to occur in the southeast region and with hospitals with fewer than 100 beds. CMS has also made a change in that some EMTALA investigations will occur 2 days after notification.

Do you know when are you required to report a potential EMTALA violation? Don’t be caught off guard. CMS issued a recent deficiency memo showing that over 4,050 hospitals received deficiencies for failure to comply with the federal EMTALA law. Most hospitals were unprepared. This makes it the most frequent area of noncompliance. Common deficiencies will be discussed.

This program will also discuss a recent case against a South Carolina hospital which was the largest EMTALA settlement of 1.2 million dollars. It is anticipated that healthcare will see larger EMTALA fines and more activity because of the higher fines and the OIG final changes. These changes are not in the CMS CoPs and will be discussed.

It will also discuss the Quality Improvement Organization process which will now be done by the two BFCC QIOs. This program will discuss the CMS memos including three CMS survey memos on Ebola and EMTALA.

Every hospital that has an emergency department and accepts Medicare and Medicaid patients must follow the federal law and the Center for Medicare and Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines on the Emergency Medical Treatment and Labor Act (EMTALA). Hospitals without emergency departments must comply with EMTALA if they have specialized capabilities. EMTALA can also impact obstetrical patients and behavioral health patients. 

This program will include the regulations and interpretive guidelines. It will include all 12 sections and an expanded section for on-call physicians and the shared and community care plan process. 
Hospitals will need to ensure their policies, procedures, and training is adequate to ensure compliance with EMTALA. The hospital must know how to do a medical screening exam, how to stabilize a patient and what constitutes an emergency medical condition. Transfers must be compliant with these requirements.

This all day program will include discussion of a case that has created an enormous expansion of hospital and practitioner liability under federal law. The case, Moses v. Providence Hospital and Medical Centers, Inc., No. 07-2111 (6th Cir. April 2009), overruled the CMS regulation that EMTALA obligations ends when the hospital admits the patient in good faith. Those states in the 6th Circuit (Ohio, Kentucky, Tennessee, and Michigan) must now follow this case as precedent. Sometimes the result may be different if the patient files a lawsuit as opposed to filing a complaint with CMS. This case illustrates the importance of understanding the role that case law has on the outcome of EMTALA litigation. Patients can complain to CMS and request an investigation or they have the option of going and directly filing a lawsuit.


Failure to comply and follow the federal EMTALA for all hospitals, including critical access hospitals, could result in loss of Medicare and Medicaid payments. Money fines can be assessed against hospitals and physicians who negligently violate the EMTALA law. There has been increased activity in the area of EMTALA.

The federal EMTALA law and the accompanying regulations are complex. This program is structured to make the requirements understandable with the liberal use of examples. 

Objectives for morning session or part 1:
• Describe that the hospital must maintenance a central log
• Discuss the hospital's requirement to maintain a list of the specific names of physicians who are on call to evaluate emergency department patients
• Recall that CMS has requirements on what must be in the EMTALA sign
• Discuss that EMTALA is the most frequent cited deficiency for hospitals