EDs deny EMTALA risk fraud, abuse citations

Even after many hospitals are issued citations, many are still violating EMTALA, says Stephen Frew, JD, a Rockford, IL-based health care attorney and consultant. "There is a general sense of denial. The usual reaction is that interpretation can’t be right because it doesn’t make good business sense," he explains. "People don’t realize that if something makes good business sense, it is probably illegal under EMTALA or Medicaid fraud and abuse."

There are still some commonly seen areas of citation, says Frew. "There are still preauthorization denials that shouldn’t have ever been happening, but definitely cannot be happening now," he notes. "Also, we continue to see citations for on-call physicians refusing to come in."

Hot spot: Mental health screenings

Another hot spot is inadequate mental health screenings. "Almost every hospital I’ve seen in the Midwest that has been cited by HCFA has had several citations for this," says Frew. "Usually, at least one is a drug overdose or suicide gesture that was considered minor, and the patient didn’t get an adequate work-up and was discharged."

Many medical staff and administrators still don’t understand the obligations of EMTALA, says Bedard. "There is still a lot of confusion about how to comply," he stresses.

Some hospitals believe they are in compliance but don’t understand the depth of the legislation, says Frew. "Others follow their HMO rules because they think they’re supposed to and don’t realize that federal law supersedes them, he reports. "So, they follow their state Medicare procedures and get nailed for a violation."

Others know the law but willfully violate it, says Frew. "For financial reasons, some administrators choose to interpret it differently, figuring they will make enough money to make that worthwhile, even if they do get cited at some point," he explains.

But that assumption is dangerous, says Frew. "An EMTALA violation has potentially devastating financial effects," he emphasizes. "To give just one example, a hospital in Arizona ended up getting suspended from Medicare from November to June, due to EMTALA and other Medicare violations. According to inside sources, it cost them over $30 million out of their cash reserves."

There are still some commonly seen areas of citation, says Frew. "There are still preauthorization denials that shouldn’t have ever been happening, but definitely cannot be happening now," he notes. "Also, we continue to see citations for on-call physicians refusing to come in."