title: Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014.
abstract: OBJECTIVE
  We determine the incidence of and trends in enforcement of the Emergency Medical Treatment and Labor Act (EMTALA) during the past decade.
  
  
  METHODS
  We obtained a comprehensive list of all EMTALA investigations conducted between 2005 and 2014 directly from the Centers for Medicare & Medicaid Services (CMS) through a Freedom of Information Act request. Characteristics of EMTALA investigations and resulting citation for violations during the study period are described.
  
  
  RESULTS
  Between 2005 and 2014, there were 4,772 investigations, of which 2,118 (44%) resulted in citations for EMTALA deficiencies at 1,498 (62%) of 2,417 hospitals investigated. Investigations were conducted at 43% of hospitals with CMS provider agreements, and citations issued at 27%. On average, 9% of hospitals were investigated and 4.3% were cited for EMTALA violation annually. The proportion of hospitals subject to EMTALA investigation decreased from 10.8% to 7.2%, and citations from 5.3% to 3.2%, between 2005 and 2014. There were 3.9 EMTALA investigations and 1.7 citations per million emergency department (ED) visits during the study period.
  
  
  CONCLUSIONS
  We report the first national estimates of EMTALA enforcement activities in more than a decade. Although EMTALA investigations and citations were common at the hospital level, they were rare at the ED-visit level. CMS actively pursued EMTALA investigations and issued citations throughout the study period, with half of hospitals subject to EMTALA investigations and a quarter receiving a citation for EMTALA violation, although there was a declining trend in enforcement. Further investigation is needed to determine the effect of EMTALA on access to or quality of emergency care.
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
authors: Sophie
authors: S
authors: Terp
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA. Electronic address: terp@usc.edu.
authors: Seth A
authors: SA
authors: Seabury
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
authors: Sanjay
authors: S
authors: Arora
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors: Andrew
authors: A
authors: Eads
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors: Chun Nok
authors: CN
authors: Lam
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
authors: Michael
authors: M
authors: Menchine
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000266:history; D003415:Crime / Q000266:history / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000266:history / Q000331:legislation & jurisprudence*; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence; D049674:History, 21st Century; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D035846:Law Enforcement / Q000266:history; D017057:Medically Uninsured / Q000331:legislation & jurisprudence; D014481:United States