HHS-OIG Settles Alleged EMTALA Violations with Tennessee and Missouri Health Systems
Two investigations by the Department of Health and Human Services Office of Inspector General (HHS-OIG) of potential violations of the Emergency Medical Treatment and Labor Act (EMTALA) have been settled with penalties of $97,500 and $258,464 to resolve the alleged EMTALA violations.
Under EMTALA, hospitals that accept Medicare payments are required to provide a medical screening examination (MSE) appropriate for the patient’s condition to any patient presenting at the hospital, regardless of their legal status, citizenship, or ability to pay. The patient must be provided with stabilizing treatment, except with informed consent, and the patient may not be transferred without stabilizing treatment unless the patient’s condition requires a transfer to a hospital that is better equipped to administer the stabilizing treatment.
The first case concerned a patient who presented at Memorial Health Care System in Chattanooga, Tennessee, in December 2021. According to HHS-OIG, a known diabetic patient presented at Memorial’s Emergency Room seeking treatment; however, had a verbal altercation with a member of staff after around 10 minutes and was escorted off the premises by law enforcement less than 10 minutes later, without having been provided with an MSE. HHS-OIG determined that this constituted an EMTALA violation and agreed to a $97,500 settlement in November 2024 to resolve the alleged violation.
The second case related to a pregnant patient who presented at the labor and delivery unit at Freeman Health System – Freeman West (Freeman) in Joplin, Missouri, in August 2022. The patient was seeking care for serious complications with her pregnancy, including bleeding, leaking amniotic fluid, and abdominal pressure and cramping. The patient had a history of miscarriage and had recently been diagnosed with deep vein thrombosis.
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An MSE was provided, and the patient was diagnosed with preterm premature rupture of membranes at 17 weeks and 5 days of gestation. The patient was advised of the treatment options, which were continued observance or induced labor. The patient was informed that if labor was induced, the fetus would not be viable; however, there was also an extremely low chance that the patient would be able to continue to carry the fetus to a gestational age where survival was likely and that failing to opt for inducted labor would place the patient at risk of serious complications including maternal thrombosis, infection, sepsis, severe blood loss, hysterotomy, hysterectomy, and death.
The patient chose to have labor induced as the stabilizing treatment; however, the hospital offered to hold the patient to observe the deterioration of the patient’s condition before performing the stabilizing treatment. That decision resulted in the patient leaving the facility to visit another hospital due to the risks of delaying treatment. That treatment was not received at the next hospital she visited and she returned to Freeman the following day. Freeman again offered to monitor the patient to some point of deterioration, at which point labor would be induced; however, due to fear of the risks of delayed treatment, the patient left Freeman to pursue treatment elsewhere and was discharged home. HHS-OIG determined that the failure to provide stabilizing treatment constituted an EMTALA violation. The case was settled with Freeman in December 2024 and a $258,464 penalty was paid to resolve the alleged violation.
