...The question in the case of Joan Grant is whether this an Emergency Medical Treatment and Active Labor Act (EMTALA) violation. The presumption is that Community Hospital and for profit is Medicare participating hospital and receiving funds from CMS and therefore subject to EMTALA law. The EMTALA las has certain condition that must be met by the treating facility. “EMTALA imposes 3 distinct legal duties on hospitals. According to the statute, only facilities that participate in Medicare are included, but this encompasses almost 98% of all US hospitals. First, hospitals must perform a medical screening examination (MSE) on any person who comes to the hospital and requests care to determine whether an emergency medical condition (EMC) exists. Second, if an EMC exists, hospital staff must either stabilize that condition to the extent of their ability or transfer the patient to another hospital with the appropriate capabilities. Finally, hospitals with specialized capabilities or facilities (e.g., burn units) are required to accept transfers of...
Words: 600 - Pages: 3
...Ethel Carew 12/28/14 EMTALA Question #1 To help determine whether EMTALA was violated in this scenario, we need to answer the following questions: • Was the patient stabilized? • Was the patient stable for transfer? • Was the patient’s transfer done in an appropriate manner? • When did the EMTALA obligation end? Was the patient stabilized after treatment for the EMC? In this scenario the Hospital personnel had fulfilled their obligation of stabilizing the patient and the patient remained in the hospital for a whole day. The patent at this point is now in an ‘in-patient’ status. No further EMTALA obligations should exist for the hospital if an identified emergency medical condition has been stabilized or if the patient in question is considered...
Words: 2385 - Pages: 10
...law requires emergency care to individuals regardless of ability to pay. EMTALA requires examination and treatment of individuals who present with an emergency medical condition and/or women who present in labor. This law is applicable to all hospitals that participate in the federal Medicare program. EMTALA should not be confused with medical malpractice law. EMTALA also applies to individuals who present with acute symptoms of psychiatric illness and/or substance abuse. The Right to Emergency Care Including the Needs of the Psychiatric Patient The Emergency Medical Treatment and Labor Act (EMTALA) requires access to emergency care regardless of an individual’s ability to pay. EMTALA may also be known as the Anti-Patient Dumping Statute. Regardless of the lack of duty to admit or serve all who present for treatment, a hospital emergency department is an exception to the rule (Showalter, 2015). A hospital emergency department has a duty to “evaluate all patients who present for service and to render emergency care to those who need it” (Showalter, 2015). The need for EMTALA was starting to be recognized in the 1960s (Showalter, 2015). According to Showalter in his text, EMTALA was developed with the “philosophy that healthcare at the time of an emergency is a moral right and must be provided regardless of the patient’s ability to pay” (2015). History Enactment The Emergency Act (EMTALA) was passed in 1986 due to increased concerns over the availability of emergency...
Words: 1578 - Pages: 7
...addresses confusion over EMTALA. (2000). hfm (Healthcare Financial Management), 54(1), 1. Brown, L. C. (2003). EMTALA compliance tips. Healthcare Financial Management: Journal Of The Healthcare Financial Management Association, 57(6), 26-28. Harman, L. (2005). HIPAA: A few years later. Online Journal of Issues in Nursing 10(2), Jost, T. S. (2009). Health care reform requires law reform. Health Affairs 28(5), 1. EMTALA (Emergency Medical Treatment and Active Labor Act) is also known as the “antidumping” law. True/False True 2. Under EMTALA, the hospital can obtain a patient’s insurance information: Both A and C are correct 3. Violations of not abiding by EMTALA, can result in: The hospital can be fined as much as $100,000 for each offense 4. Under EMTALA, when can a hospital transfer a patient to another facility? Answers B & C are correct 5. Under EMTALA, Federal law requires that medical screening and stabilization is to be provided only in emergency situations (i.e., not for non life-threatening conditions the patient may go to the emergency department for). False 6. Under EMTALA, it is okay for hospital staff to let the patient (or their family member) know that they will receive emergency treatment regardless of their ability to pay. True 7. If a patient decides to leave before being screened, under EMTALA, the following should...
Words: 534 - Pages: 3
...Regulations Stephanie Sauceda HCS/545 March 17, 2014 Mary Cummings Health Law and Regulations Health care in the United States has changed over the years and the federal government saw need to establish regulatory agencies such as the Centers for Medicare & Medicaid Services (CMS) to ensure the elderly, disabled and low income receive quality and cost-effective health care. As a result of health care costs sharply increasing, the government determined it needed to have oversight on the health care industry and pushed for the establishment of managed care organizations (MCO). CMS enforces the Emergency Medical Treatment & Labor Act (EMTALA); this act was created to ensure health care organizations provide a minimum of a medical screening exam to determine if complaint is emergent or not. Most importantly for EMTALA is the obligation to treat emergent cases regardless of the patient’s ability to pay for services. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was approved by the United States Congress to regulate the use of and protect patient health records and the Department of Health & Human Services oversees the compliance and violations of HIPAA (Department of Health & Human Services, n.d.). The intentions of many of these regulatory agencies is to oversee that the health care industry is providing quality, affordable health care and treating patients with fairness and privacy. In 2008, the Centers for Medicare & Medicaid...
Words: 1686 - Pages: 7
...University of Phoenix Material Health Care Resources Matrix Research 4 to 5 health care laws related to health care resource allocation. Complete the table below: |Health Care Law |Describe the health care law (75 to 150 words) |Analyze the importance of the law (75 to 150 words)|Analyze the impact the law has on health care | | | | |resource allocation | | | | |(75 to 150 words) | |Affordable Care Act (ACA)- March 23, 2010 |The Individual directive requires all Americans|Affordable Care Act (ACA) or Obama Care is making |The ACA prohibits a health plan from canceling | | |to maintain health insurance. The Employer |health care more affordable and more accessible to |coverage of an enrollee except in the case of fraud | | |directive requires all employers with 50 or |all people. The Affordable Care has provided |or intentional distortion. Before the ACA the | | |more full-time equivalent...
Words: 1192 - Pages: 5
...Abstract The Affordable Care Act (ACA) brings a myriad of changes to the healthcare system and hospitals must adapt accordingly or face dire financial challenges. Some of the financial challenges will originate from the influx of Medicaid patients due to the Medicaid expansion. Based on these changes, there is an increased tendency for hospitals to engineer ways to reduce costs such as patient selection and staff reduction. However, for a hospital to participate in Medicare, which accounts for more than 50% of hospital budgets, certain laws and regulations must be followed. This paper discusses these laws and regulations and offers suggestions on how to adjust successfully to the upcoming changes. The Affordable Care Act (ACA) and Hospital Compliance In light of the current changes in the healthcare industry, it is imperative for every healthcare organization to adapt accordingly or face dire financial challenges. A major change included in the Affordable Care Act (ACA) is the expansion of Medicaid, which will provide coverage to millions of formerly uninsured US citizens and permanent residents (Rosenbaum, 2011). However, Medicaid is notorious for much lower reimbursement compared to Medicare and private/commercial insurance (M. Schmitt, personal communication, October 7, 2013). In addition, hospitals are now required to prove that the services they bill for actually improve and maintain patients’ health (Leonard, 2013). Hospitals are also required...
Words: 1541 - Pages: 7
...Health Law and Regulations Daniel Sanchez Health Law and Ethics/545 August 19, 2013 Mary Cummings Introduction Over the past several decades America has witnessed overwhelming increases in health care cost and a diminishing quality of care. The involvement of government sets the expectations of enforcing laws and regulations on how health care is delivered in the United States of America. Healthcare legislation has been defining regulatory agencies for centuries. The primary existence of these government-regulated agencies is to ensure that laws and regulations are enforced. Access to quality and affordable healthcare is protected through government regulatory agencies. In addition to the escalating cost of healthcare and increasing society’s debt both positive and negative effects has transpired. The pros and cons of improving care and reducing the cost of healthcare has been the goal of regulatory agencies from the beginning. Controlling healthcare cost and delivering quality care is made possible through health care legislation. The following will discuss governmental regulatory agencies and its effects on the healthcare industry. Government Regulatory Agencies and Their Role Federal regulatory agencies are in place to govern issues that impact the people of the United States. These agencies have been in existence for hundreds of years. Situations that impact the American society are inclusive to things that have a direct personal affect on them individually...
Words: 1606 - Pages: 7
...This assumption is largely due to the EMS regulations that patients are not required to pay for on-scene treatment, and the fact that the EMTALA has remained an unfunded mandate(Fitch). They argue that the EMTALA is causing the loss of a lot of money by treating patients who cannot pay. While those claims may have some ground, EMS is a continually changing industry, starting this year, 2018, patients will be required to pay for on-scene treatment. This new agenda is approved to lessen the burden on taxpayers, however, the EMTALA still stands, if patients are truly unable to pay but more extensive background checks will be conducted to determine whether or not the patient is truly in...
Words: 1844 - Pages: 8
...Public Health Preparedness Mary Anderson Strayer University Health Policy and Law Basics Professor Dorothy Moore December 15, 2013 Abstract Healthcare is one of the top social and economic problems in America today. The United States is considered by most to be the greatest country to ever grace the face of the planet. It has the largest military, the largest economy, freedom of speech and religion, and one of the first successful democracies and of course, the American dream. Yet, what is the one thing that most people seem to forget? That the United States of America, the most dominant force in the world, is also the only westernized industrial nation without a Universal Healthcare system(Capretta, Moffit, 2012). Public Health Preparedness Examine the existing procedures related to at least four of the ten essential public health services. Focus on the principal effects that these procedures will have on your hospital during the emergency. The public health system includes: Public health agencies at state and local levels, Healthcare providers, Public safety agencies, Human service and charity organizations, Economic and philanthropic organizations and Environmental agencies and organizations As the new Vice President of quality and safety; emergency preparedness is achieved by planning, training, equipping, and exercising the emergency response organization. The framework of public health systems monitors the health status in order...
Words: 2239 - Pages: 9
...* Health Care Economic Issues Outline * I. Introduction A. More than 50 million uninsured in the United States (Young, 2012) B. Uninsured population is considered vulnerable population C. Uninsured use emergency department to meet their primary health care needs D. Overcrowded emergency departments require reallocation of resources * II. Effectiveness of the Current Procedures in Place * A. Federal Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals * to treat every patient irrespective of the payer source B. Limited community resources forces uninsured population returning to emergency department for minor ailments C. Shrinking federal and state funding for medical assistance programs D. Current procedures do not address medical needs of the undocumented populations * E. Treating uninsured costs taxpayers more than $175 billion per year (KFF, 2008) F. Hospitals absorb more than $65 billion dollars per year in uncompensated care III. Affects of financial decision-making process A. Express/Urgent Care areas added to emergency B. PA added to Triage to treat minor health issues C. Sponsor Care Funds Created 1. Hospitals have created sponsor care programs designed to help alleviate the amount of debt created by an insured patient. The funding for sponsor care programs comes from direct donations from the community and are meant specifically for patients that are receiving...
Words: 1600 - Pages: 7
...Comparative Analysis Rural hospitals across the world are being affected financially. Rural communities are less wealthy; the majority of the residents are uninsured. They tend to use the emergency room as their primary care, putting a financial burned on the hospital. In 1986 the Emergency Medical Treatment and Labor Act (EMTALA) was enacted by congress as part of the Consolidated Omnibus Reconciliation Act (COBRA). EMTALA allows uninsured patients to receive care with an emergency condition regardless of insurance status or the ability to pay. The law states the patient may not be turned away and care cannot be delayed due to pay concerns. EMTALA requires the hospital to stabilize the patient before transferring or discharging the patient (Encyclopedia of Everyday Laws, 2013). According to The Center for Disease Control (CDC), about 135 million people visit the emergency room each year and hospitals lose approximately $34 billion in unpaid medical bills. With the passing of the Patient Protection Affordable Care Act many unnecessary or preventable emergency room visits will be eliminated. My action plan for Ashe Memorial Hospital is to design a program to decrease the number of uninsured patients using the Patient Protection and Affordable Care Act (PPACA). By decreasing the number of uninsured people, it will also: • decrease the number of emergency room visits • increase the number of people to receive preventative care • increase the quality of patient care A...
Words: 995 - Pages: 4
...Question 1 - INCORRECT Which statement is true about screening for domestic abuse? Your Answer: Healthcare providers should screen for abuse only if the patient has physical injuries. Healthcare providers should routinely ask patients about abuse. Rationale:Healthcare providers should routinely ask direct questions about domestic abuse. Depending on facility policy, routine inquiry may include all adult and adolescent patients, or female adolescents and adults only. Question 2 - Correct Age-specific competencies are assessed for accreditation by The Joint Commission. Each employee must be able to: Your Answer: All of these abilities must be demonstrated Rationale: To be considered competent under The Joint Commission standards, an employee must demonstrate all of these abilities. Question 3 - Correct Which of the following is a key law that makes it illegal to submit a falsified bill to Medicare? Your Answer: Federal False Claims Act Rationale: The Federal False Claims Act makes it illegal to submit a falsified bill to Medicare. The Stark Act makes it illegal for providers to refer patients to a provider or facility with whom the referring provider has a financial relationship. HIPAA protects a patient’s privacy and Miranda is a safeguard against false arrest. Question 4 - INCORRECT A patient has a living will. The patient is in a serious accident and loses the ability to make and communicate healthcare decisions. The patient suffered brain...
Words: 645 - Pages: 3
...Immigration Reform Is Imperative John Doe University of Good Times Almost 350,000 immigrants sneak into the United States illegally each year. Typically these people immigrate to the United States in hopes of finding employment to support their families. Once here, about 70% of them will obtain employment. The jobs that illegal immigrants occupy are the lower end jobs, which hurt unemployment rates especially for the lower class. Illegal Immigrants costs the United States about 113 billion each year. These costs are spread out over our education system, medical care, judicial system, and more. The information presented in this research paper will address the seriousness of this issue. Illegal immigration has a negative impact on the United States in many ways. Immigrants have entered our country illegally and stolen millions of jobs, crippled a struggling education system, manipulated welfare programs, and drastically raised crime rates. Without immigration reform, the crippling effects of illegal immigrants will break this country. With illegal immigrants willing to work for less pay and in poor work conditions, they negatively impact employment rates. Illegal-immigration has a negative impact on the available jobs for U.S. citizens. People often protest that the illegal immigrants do the jobs that Americans don’t want to do. However, that is not the case. They are able to work for low wages and in poor conditions, where citizens must follow minimum wage...
Words: 1876 - Pages: 8
...False Claims Act The False Claims Act was established to prevent intentionally inaccurate claims against or to the government for property or money. This applies to all federal programs, although it is applied to health care most frequently due, in part, to the large dollar amounts involved1, but also to the volume of claims regarding health care made to the federal government each year. There are five elements pertaining to the establishment of a false claim under the False Claims Act; 1) a claim for property or money is made; 2) the claim is against or to a department or agency of the United States; 3) the claim was false, fictitious or fraudulent; 4) the organization, or persons representing the organization, must have known at the time that claim was false, fictitious or fraudulent; and 5) the false, fictitious or fraudulent claim was material.2 Qui Tam. When an individual (relator) brings a lawsuit against an organization claiming violation of the False Claims Act, this is considered a “qui tam” action. A relator’s knowledge, used to bring about a qui tam suit, “must not be public knowledge but information that would not otherwise be available without the qui tam suit.”1 The relator, often referred to as a “whistleblower”, receives a portion of any settlement amount dictated by the results of a qui tam suit. This incentive was established by the False Claims Act and encourages individuals to assist the government in identification of fraud.1 HIPAA Privacy Standards ...
Words: 947 - Pages: 4
