Two EMTALA Violations causes in Hospital Emergency Department

Two EMTALA Hospital Violations

Two Surprising—But Common—Causes of EMTALA Violations

The Emergency Medical Treatment and Labor Act (EMTALA) is full of concepts that seem straightforward, so why are EMTALA violations so common for hospitals? Although EMTALA requirements are seemingly simple, they quickly get confusing when they’re applied to real patients in real-life situations. And if a patient or even another hospital files a complaint, it could trigger an EMTALA survey. Will you be ready when the surveyor shows up?

There are many different factors that complicate EMTALA compliance, and that’s bad news for Medicare-participating hospitals. EMTALA violations are expensive: hospitals—and physicians—can be fined up to $50,000 per violations ($25,000 for hospitals with fewer than 100 beds), or even have their Medicare billing privileges revoked.

The intent of EMTALA is to prevent hospitals from turning away patients due to lack of insurance coverage or financial means. But in reality, less than 20 percent of violations involve refusing treatment for financial reasons. The rest are due to confusion over the rules, or so-called “technical” violations—violations where there is no complaint or adverse outcome, but nevertheless a requirement wasn’t met.

Fewer Resources, More Violations

Increasing patient volume at emergency departments, along with tight resources create pressure on physicians, nurses, and hospital staff to do more, with less. That creates an environment ripe for EMTALA violations.

In some areas, substance abuse, behavioral health issues, and a significant homeless population mean that emergency department staff are seeing the same faces over and over again. When a patient has presented several times under the influence of alcohol or drugs, or is a known drug seeker, it can be all too easy for hospital staff to dismiss them without conducting an EMTALA-compliant medical screening.

It’s frustrating for hospital staff to spend precious time and resources on a patient who has presented disingenuously, but acting on that frustration puts your hospital at risk of an EMTALA violation. Hospital staff must understand that the proper screening process applies every single time, to every single patient, regardless of patient history.

Know the Definition of Dedicated Emergency Department

EMTALA contains language that seems simple enough, but the actual meaning of these terms isn’t exactly common sense. One example is “dedicated emergency department” (DED). It seems odd that a facility could have one and yet not know it, but consider that according to EMTALA, a DED is any department in the hospital (which includes hospital-owned areas within 250 yards of the main hospital building) that meets at least one of these criteria:

  1. Licensed as an emergency department: This is the easy one, a traditional emergency department, for example.
  2. Represented to the public as a place that provides care for emergency medical conditions on an urgent bases without requiring an appointment. Think about how you advertise your facility to the public. “Representing” can mean though advertising, facility name, posted signs, or other means.
  3. One-third of all walk-ins in the past calendar year have received outpatient treatment for an emergency condition. This is based on a representative sample of patients. Patients must have been treated on an urgent basis without requiring a previously scheduled appointment.


According to this definition, hospital-owned urgent care centers or behavioral health centers could be subject to EMTALA. If, however, your facility does not offer organized emergency services, some experts recommend advertising “No emergency services” to head off any trouble. Keep in mind that even if your facility does not provide emergency services, you must still comply with Medicare Conditions of Coverage and EMTALA rules for accepting hospitals.


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