Emergency Care: EMTALA Implementation and Enforcement Issues

A letter report issued by the General Accounting Office with an abstract that begins "In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in response to reports that some emergency rooms across the country had refused to treat indigent and uninsured patients or had 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 Centers for Medicare and Medicaid Services (CMS) are responsible for investigating complaints of alleged violations and forwarding confirmed violations to the Department of Health and Human Services' (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 for hospitals and physicians, such as overcrowded emergency departments. 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. Hospital and physician representatives told GAO that EMTALA has helped to ensure access to emergency services and has reduced 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. At the same time, many hospital officials and physicians said that EMTALA has adversely affected the efficiency and type of services provided in hospital emergency departments and has resulted in additional costs to hospitals and physicians. Some hospitals and physicians 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 number of EMTALA violations and fines have been relatively small, and the hospitals' Medicare provider agreements have rarely been terminated.