The Emergency Medical Treatment and Labor Act (EMTALA)

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Last Updated: 09-11-2024

The Emergency Medical Treatment and Labor Act (EMTALA), also known as the patient dumping statute, is a federal law that imposes specific obligations on Medicare-participating hospitals that offer emergency services. EMTALA requires that anyone coming to an emergency department requesting evaluation or treatment of a medical condition, receives a medical screening examination. If they have an emergency medical condition, the hospital must provide stabilizing treatment, regardless of the patient's insurance status or ability to pay. If the hospital does not have the capabilities required to stabilize the patient, the hospital must provide an appropriate transfer to a hospital that can provide the needed treatment. A hospital that has the needed specialized capabilities and capacity may not refuse to accept the transfer.

The Health and Human Services Office of Inspector General (HHS-OIG) may seek a Civil Monetary Penalty (CMP) against any hospital that has negligently violated its obligations under EMTALA.

How Does HHS-OIG Enforce EMTALA?

HHS-OIG receives referrals for potential CMP cases under EMTALA from the Centers for Medicare & Medicaid Services (CMS). CMS assesses a Medicare-participating hospital's compliance with EMTALA under the hospital's Medicare Provider Agreement. CMS reviews and investigates EMTALA complaints and then determines whether a hospital is in compliance with its Medicare Provider Agreement.

HHS-OIG's EMTALA enforcement involves HHS-OIG bringing a legal action against a hospital for a CMP. HHS-OIG's EMTALA enforcement actions are predicated on an evaluation of legal liability and the appropriate assessment of the penalty amount. Hospitals have a right to request a hearing before an Administrative Law Judge challenging both HHS-OIG's finding of a negligent violation of EMTALA and the amount of the CMP.

HHS-OIG EMTALA Enforcement Procedures

HHS-OIG carefully evaluates potential EMTALA enforcement cases and determines whether to pursue a CMP. HHS-OIG considers certain factors to determine an appropriate CMP amount. These factors are published in regulations. If HHS-OIG determines that pursuit of a CMP is appropriate, it communicates that to the provider in an informal process and, in most cases, negotiates a settlement. If a negotiated settlement is not reached, HHS-OIG may then start the formal administrative process, which moves the case to a litigation phase. This administrative litigation typically involves discovery, pre-trial motions, trial, and post-trial briefing before an Administrative Law Judge. If the Administrative Law Judge upholds the CMP against the hospital, the hospital may appeal the decision to an appellate administrative panel and then to federal court.

EMTALA Enforcement Actions

Below are links to summaries of selected EMTALA settlements between HHS-OIG and hospitals. In each EMTALA CMP case resolved through a settlement agreement, the settling party does not admit to liability.

Additional Enforcement Actions

Resources

There are informational resources on CMS's website, here, to help individuals understand their rights under EMTALA and the process for submitting a complaint if they are denied emergency medical care.

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