United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-06-22 monographic deposited born digital 38 p. GA 1.13:GAO-01-747 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-747 P0b002ee18037c487 f:d01747 DGPO 2010-08-12 2011-03-28 GAOREPORTS-GAO-01-747 machine generated eng fdlp REPORT GAOREPORTS-GAO-01-747 GAO-01-747 Medical examinations Emergency medical services Disadvantaged persons Hospitals Health insurance Fines (penalties) Medicare Program Other Written Product A01241

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 primarily in response to concern that some emergency departments across the country had refused to treat indigent and uninsured patients or inappropriately transferred them to other hospitals, a practice known as "patient dumping." EMTALA requires hospitals that participate in Medicare to provide a medical screening examination to any person who comes to the emergency department, regardless of the individual's ability to pay. If a hospital determines that the person has an emergency medical condition, it must provide treatment to stabilize the condition or provide for an appropriate transfer to another facility. The regional offices of the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) are responsible for investigating complaints of alleged EMTALA violations and forwarding confirmed violations to HHS' Office of Inspector General (OIG) for possible imposition of civil monetary fines. The medical community has raised concerns that the implementation and enforcement of EMTALA have created burdens, such as overcrowded emergency departments, for hospitals and physicians. This report reviews (1) how EMTALA has affected hospital emergency departments and delivery of emergency care and (2) how CMS and OIG have enforced EMTALA. GAO found that hospital and physician representatives noted that EMTALA has been beneficial in ensuring access to emergency services and reducing the incidence of patient dumping. However, the overall impact of EMTALA is difficult to measure because there are no data on the incidence of patient dumping before the law's enactment. Many hospital officials and physicians stated that the implementation of EMTALA adversely affects the efficiency and type of services provided in hospital emergency departments and results in additional costs to hospitals and physicians. Furthermore, some hospitals and physicians, however, expressed uncertainty about the extent of their responsibilities under EMTALA. Regarding enforcement, CMS has the authority to terminate the Medicare provider agreement of a hospital that has violated EMTALA and also forwards confirmed violations to the OIG for possible imposition for civil monetary fines. Since the law's enactment, the numbers of EMTALA violations and fines have been relatively small, and the hospitals' Medicare provider agreements have rarely been terminated. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-747/html/GAOREPORTS-GAO-01-747.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-747/pdf/GAOREPORTS-GAO-01-747.pdf GAO-01-747 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-747 Other Written Product GAO-01-747; Emergency Care: EMTALA Implementation and Enforcement Issues; Medical examinations Emergency medical services Disadvantaged persons Hospitals Health insurance Fines (penalties) Medicare Program Title 42 Section 1395cc Title 42 Section 1395dd Title 42 Section 1395i Title 42 Section 1395w 42 U.S.C. 1395cc 42 U.S.C. 1395dd 42 U.S.C. 1395i 42 U.S.C. 1395w Public Law 99-272 Public Law 101-239 Public Law 105-33 Public Law 106-554 Title 42 Part 489.20 and Sec 42 CFR Part 489.20 and Sec Title 42 Part 489.24 42 CFR Part 489.24