EMTALA Enforcement Is Alive — “Patient Dumping”

When Congress passed EMTALA in 1986, the intent was clear: prevent hospitals from refusing care or transferring patients solely because they lacked insurance or ability to pay.

Under the statute, any hospital that participates in Medicare and operates an emergency department must:

• Provide a medical‑screening examination to anyone who presents with an emergency, regardless of payment status;

  
  

• If the patient has an emergency medical condition, the hospital must stabilize that condition — or, if unable, arrange an appropriate transfer under EMTALA rules.

  
  

• And perhaps most critically: Even hospitals with specialty or psychiatric services have an obligation to accept transfers when they have both capacity and capability — without regard to a patient’s insurance status or financial means. 

That requirement to accept appropriate transfers is one of the key protections of EMTALA — ensuring that patients are not “dumped” simply because they’re uninsured or difficult to treat.

What Went Wrong at Brentwood Behavioral Healthcare of Mississippi

In May 2025, the Office of Inspector General (OIG) announced that Brentwood agreed to pay $350,000 to resolve allegations that it violated EMTALA when it refused to accept transfers of seven individuals who required psychiatric emergency care — despite having capacity and the relevant capabilities to treat them.

According to the OIG’s determination, Brentwood declined the transfers because the patients were uninsured and being transferred from a considerable distance — not because of lack of bed space or capability, which is explicitly prohibited under EMTALA.

This is a textbook case of “patient dumping”:

• A hospital with specialty services refusing to accept a transfer

• Not due to lack of capacity or clinical reasons

• But due to a non‑clinical factor — in this case, insurance status or financial risk

Why These Cases Still Happen — And Why They Matter

Despite EMTALA’s long history, patient dumping remains a recurring issue:

• Historically, before EMTALA, the practice of denying or transferring uninsured or indigent patients was common.

  
  

• While enforcement has decreased over time, the risk persists — particularly in psychiatric hospitals, for-profit facilities, or institutions experiencing financial stress.

  
  

• Between 2005–2014, nearly 43% of hospitals with Medicare agreements faced EMTALA investigations; about 27% were cited.

Why does this keep happening? Often because:

• Hospitals are pressured to control costs — psychiatric and behavioral‑health facilities may see uninsured patients as financial losses.

  
  

• Some decision‑makers wrongly believe they can refuse transfers based on insurance or distance — even though EMTALA prohibits such non‑clinical refusals.

  
  

• Oversight or governance structures may be weak, or there may be inadequate awareness of EMTALA obligations among leadership.

The consequences — demonstrated by the Brentwood settlement — are real: civil monetary penalties, financial liability, and reputational damage.

Key Lessons for Compliance, Risk, and Hospital Leadership

For those managing compliance and risk programs, these enforcement actions offer clear takeaways:

• EMTALA applies regardless of payer status. Capacity and capability matter — not insurance or credit risk.

  
  

• Hospitals with specialized services have a legal duty to accept transfers when capable. That includes psychiatric, burn, neonatal, trauma, or other specialty services.

  
  

• Document decisions carefully. If a transfer is refused, the clinical and capacity rationale must be clearly documented — not financial considerations.

  
  

• Training must include EMTALA transfer obligations, not just screening and stabilization — particularly in facilities that frequently receive transfers.

  
  

• Governance and oversight must stay active. Regular audits, leadership awareness, and a compliance mindset help ensure non‑discriminatory, patient‑centric practices.

Final Thought

EMTALA isn’t optional lip service — it’s a legal foundation meant to protect vulnerable patients in crisis. When hospitals or behavioral‑health facilities sidestep these obligations, the result isn’t just a regulatory fine — it’s a breach of fundamental patient rights.

The cost of non‑compliance isn't just financial. It’s moral.

As compliance and privacy professionals, it’s our job to help ensure that these protections remain lived reality — not forgotten in the face of financial or operational pressure.

If you’d like to learn more about this topic, please see the OIG’s website on EMTALA enforcement:  https://oig.hhs.gov/fraud/enforcement/?type=emtalapatient-dumping&action-details-date=all#results

Do you have questions about how to review your transfer‑acceptance policies under EMTALA? Please contact jessicazeff@simplycomplianceconsulting.com.