Beware: The feds are raising the stakes on Emergency Medical Treatment and Labor Act (EMTALA) violations – which should have hospitals rather nervous. In fact, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently doubled EMTALA fines. Don’t get caught falling for a common mistake—that is, ambulance-related noncompliance.
Also known as the “Patient Anti-Dumping” law, EMTALA typically applies to hospital emergency departments (EDs), but there are also special compliance considerations under the law for ambulance services, notes healthcare attorney and EMTALA expert Joseph McMenamin in his webinar, “EMTALA Regulations & Compliance Virtual Boot Camp.” And unfortunately, many providers aren’t clear on the EMTALA rules for ambulances.
Learn Which Ambulances Are Subject to EMTALA
Enacted in 1986, EMTALA was designed to encourage Medicare-participating hospitals to provide non-discriminatory care for patients regardless of their citizenship, legal status in the country, or ability to pay for medical services, according to Very Well Health. And in certain instances, EMTALA applies to ambulances as well.
Specifically: EMTALA applies to a patient in a hospital-owned air or ground ambulance, regardless of whether the ambulance is located on hospital property, explains Honigman Miller Schwartz LLP.
Exceptions: But EMTALA does not apply to hospital-owned air or ground ambulances if:
- The ambulance is operated under communitywide emergency medical service protocols that direct it to transport the individual to a hospital other than the hospital that owns the ambulance (for example, the closest available hospital); or
- The ambulance is operated at the direction of a physician who is not employed or otherwise affiliated with the hospital that owns the ambulance.
What’s more: Generally, if a hospital owns or operates the ambulance service, EMTALA will apply regardless of whether the ambulance is on hospital grounds, according to Holland & Hart LLP. But for ambulances not owned/operated by a hospital, EMTALA does not apply unless and until the ambulance is inbound to the hospital or arrives on hospital property.
The Interpretive Guidelines state: “An individual in a non-hospital owned ambulance not on the hospital’s property is not considered to have come to the hospital’s emergency department when the ambulance personnel contact [the hospital] by telephone or telemetry communications.” In that case, EMTALA does not apply, and the hospital may direct the ambulance to another facility.
Avoid ‘Diversionary Status’ Pitfalls
Not so fast: But if the hospital is in diversionary status (meaning, it doesn’t have the staff or facilities to accept any additional emergency patients) and the patient nevertheless comes to the hospital property, EMTALA will apply.
Once the ambulance is inbound to the hospital, however, the hospital may not divert the ambulance unless on diversionary status, Holland & Hart warn.
Tip: “Given the potential confusion over when and if an ambulance is inbound, hospitals generally should not refuse to accept a patient when contacted by the ambulance crew unless they are on diversionary status,” according to Holland & Hart.
Crucial: Make sure your hospital staff carefully document the time, need for, and notice of diversionary status to emergency services personnel.
If an inbound ambulance is not owned by your hospital, you may divert the ambulance to another facility if you’re on diversionary status. And even if your hospital is not on diversionary status, you may still send an ambulance to another facility if you effect an appropriate transfer under EMTALA regulations.
If appropriate, based on the patient’s condition and your hospital’s capabilities, you may recommend that the ambulance crew take the patient to another facility, Holland & Hart note. In this situation, explain to the ambulance understands that you’re not diverting the ambulance—your hospital will receive the patient if brought to your facility; rather, you’re merely discussing the best care options for that patient.
EMTALA Noncompliance is Costly
Bottom line: Considering the high risks of ever-increasing penalties, private lawsuits, and termination of your Medicare payments, your hospital must stay on top of its EMTALA compliance at all times, affirms attorney Joseph McMenamin.
Beware that EMTALA regulations are ambiguous in their application and interpretations, so you need all the concrete, real-world compliance strategies that you can get: McMenamin offers just that in his EMTALA Regulations & Compliance Virtual Boot Camp.