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Compliance Officer Tips

The Emergency Medical Treatment and Labor Act (EMTALA) remains a compliance high-risk area. It has been cited as such by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) since the issuance of its original compliance guidance documents. The OIG recently issued revised regulations that (1) increase the civil monetary penalty amounts for EMTALA violations; and (2) encourage providers to self-report EMTALA violations to the Centers for Medicare & Medicaid Services (CMS) in order to potentially receive more lenient penalties when a violation of the law has occurred. Compliance Officers should ensure that the EMTALA high-risk area is being addressed by ongoing monitoring and auditing. The following are suggestions and tips for Compliance Officers:

  1. Ensure EMTALA Policies Address:
  • The requirement that screenings be conducted by physicians or qualified medical personnel;
  • A detailed screening protocol;
  • A process for reassessing patients after initial screenings;
  • Documentation and uniformity of screenings regardless of ability to pay;
  • Conduct and timeframes for stabilization of patients as required under EMTALA;
  • The transfer process and patients’ rights;
  • Requirements for physician certifications and medical record documentation for transfers;
  • A process for transfers into the hospital;
  • Patient consent requirements;
  • Requirements for refusals of emergency transfers;
  • State-specific transfer requirements;
  • Prohibition of retaliation against whistleblowers;
  • Methods to internally report and address potential violations and conduct timely investigations; and
  • A process for addressing any changes in laws, regulations or accreditation standards.

 

  1. Training on Policies. The key to a successful EMTALA program is to educate frontline staff on policies to ensure that they are followed appropriately. All new staff assigned to the Emergency Department should first undergo intensive training on EMTALA policies, then receive annual refresher training. The training should include scenarios that address real-life situations to prepare staff to make quick decisions on the job appropriately.

 

  1. Ensure EMTALA Investigating and Reporting Responsibilities Have Been Resolved. EMTALA complaints can come from many sources, including other hospitals, patients, family members, and ambulance companies. They are also frequently reported to CMS and the OIG. It is critical that reported EMTALA issues are addressed promptly and appropriately, which regulatory authorities and enforcement agencies view seriously. Clinical leadership should play a key role in this reporting process but also understand when and how they must work with the Compliance Officer and Legal Counsel. Legal Counsel must be involved in the investigations process and interactions with government agencies. Since there is potential for a private cause of action under EMTALA, it is important that investigations are conducted with the Legal Counsel’s direction in order to preserve privilege where necessary and appropriate.

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