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Serious EMTALA violations charged in charity lawsuits
When it comes to EMTALA, you don’t want to just toe the line, says Bryan Liang, PhD, a professor of law, medicine, and public policy at California Western School of Law in San Diego. You want to be so far away from the line that no one could even suggest you crossed it.
"You’re not supposed to talk about insurance before the patient is seen, so any time they do that it is an EMTALA violation. I think that’s a slam-dunk," he says. "There might be some exaggeration in the lawsuit about what actually happens in these hospitals, but there is usually a kernel of truth in the allegation somewhere. You don’t want to get anywhere near that EMTALA violation line."
Liang suggests that risk managers should review — again — how their emergency department staff discuss payment with patients. Be on the lookout for systems and procedures that might be technically acceptable but still come too close to a violation. "If they wait until the examination is under way or just finished and then they bring in the paperwork and bring up the financial issue, that’s not before stabilization, but it’s so close that it can look like coercion. Any appearance of impropriety can invite a closer look and fines."
Liang recommends waiting until the patient is discharged, then inquiring with the patient about a payment plan or other options. That might not be the way to optimize collections, and it won’t be recommended by the CFO. But he says it is the risk manager’s job to contradict those optimal collections practices when they put the organization at risk.
"CFOs are not necessarily equipped to understand the intricacies of EMTALA or what the community is thinking of you," Liang says. "CFOs have their own agenda and it’s all about increasing revenue. It might be your job to say this is not the right thing for us to do, even if it costs us."