Patient Dumps Can be Costly (But Cheaper than Missing Signature under Stark)

Continuing an accelerating series of EMTALA investigations and settlements in 2014 and this year, a Newton, Kansas hospital has agreed to pay $45,000 to settle allegations by the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services that it violated the Emergency Medical Treatment & Labor Act (EMTALA) by failing to provide an adequate medical screening examination for a pregnant woman who was later admitted to another hospital. The woman ultimately gave birth to a stillborn baby.

The OIG’s press release, posted on its website on March 17, 2015, alleged that Newton Medical Center failed to provide an adequate medical screening examination for the woman, even though she came to Newton’s emergency department 38-weeks pregnant and complaining of abdominal and lower back pain. Instead of examining the woman, Newton allegedly told her to see her personal physician—without taking her medical history or performing any vitals or exams on her. The woman left Newton in her own car and went to another hospital, where she was admitted and delivered the stillborn baby.

OIG has statutory authority to impose civil monetary penalties (CMPs) in an amount up to $50,000 for EMTALA violations. CMPs are in lieu of Medicare exclusion, the Agency’s ultimate hammer, but do not preclude private civil lawsuits, which frequently accompany OIG enforcement actions.

The Newton settlement follows on the heels of another EMTALA settlement by OIG just this January. That one involved a Tennessee hospital that paid $40,000 to resolve an alleged dump of an uninsured patient who had drank a bottle of antifreeze and presented in the settling hospital’s emergency department. The OIG settled a total of fifteen alleged EMTALA violations in 2014.

Although EMTALA settlements have been entered for as little as $10,000, these investigations typically involve much greater defense costs and institutional expense—to say nothing of the unquantifiable damage to the institutions’ public images. Even so, observers might well question policy-makers’ enforcement priorities in light of the large discrepancy between the settlement values of EMTALA cases—most of which involve real harm to patients—and the far greater settlements extracted by the government in Stark and Anti-kickback matters, where direct patient harm is rarely present.

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