In April, the OIG announced a settlement with a Georgia Hospital for requiring a patient to pay an up-front charge before being seen for a medical screening examination. OIG settlements are “contested” in the sense that the hospital does not agree that they did anything wrong or what they were alleged to have violated. The $25,000 is the maximum civil monetary penalty for a hospital of less than 100 beds. Hospitals above 100 beds can be fined a maximum of $50,000 per incident.
The OIG announcement on its webpage states:
“04-04-2013
Donalsonville Hospital, Inc. (Donalsonville), Georgia, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Donalsonville failed to provide an adequate medical screening examination to a patient who presented to their emergency department complaining of shortness of breath and chest pain. The patient did not receive any medical examination from a physician and was told he was required to pay a minimum fee of $100 to continue further treatment. The patient chose not to pay the fee and was discharged without receiving an appropriate medical screening examination. The delay in the provision of an appropriate medical screening examination and the imposition of a minimum fee to receive an appropriate medical screening examination were inappropriate.”
The alleged actions of hospital personnel are typical of many hospitals that are attempting to increase cash flow with up-front demands for payment in “non-emergency” cases after a superficial triage or assessment.
This practice was a common occurrence in the early days of EMTALA, when it was referred to as “Triage Out”, but disappeared from common practice when CMS issued dozens of hospital citations under EMTALA to slam the door on Triage Out. Even hospitals with NPs or PAs providing initial assessments were found in one study to miss potential emergency cases in 20% of the presentations.
The practice has resurfaced with hospitals facing financial pressures of a serious recession that seemingly refuses to improve. It is often justified on the grounds that ED over-crowding is caused by minor presentations that should be seen in a physician’s office or urgent care clinic, but leading studies have documented that delays in admitting patients to the hospital are the primary cause of ED backups.
I have always taken the position that it is a poor strategy to try to drive patients out of the ED from all aspects — compliance, liability risks, and patient/community relations. When it comes to finances, if the first three aspects are not enough potential loss, this case demonstrates that it is not cost effective if even 1 patient in 250 “non-emergency” patients is inadequately assessed. And before you jump up and assure me that your facility would NEVER make a mistake like this one, your CEO may want to believe that, but I am not that gullible. Mr. Murphy and his “law” visits us all at one time or another.