Hospital Penalties for Noncompliance

9120 – Hospital Penalties for Noncompliance (Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16) Hospitals that fail to meet the requirements of §1867 or the EMTALA-related requirements of §1866 may have their Medicare provider agreements terminated. In addition, a hospital with fewer than 100 beds is subject to an OIG-levied Civil Monetary Penalty (CMP) of up to $25,000 for each negligent violation, while a hospital with 100 or more beds is subject to fines of not more than $50,000 per violation. A physician who is responsible for the examination, treatment, or transfer of an individual in a participating hospital, including a physician on-call for the care of such an individual, and who negligently violates a requirement, is subject to a CMP of not more than $50,000 for each such violation, and if the violation is gross and flagrant, or repeated, to exclusion from participation in Medicare and State health care programs. A participating hospital may not penalize or take adverse action against a physician or a qualified medical person because either practitioner refuses to authorize the transfer of an individual with an emergency condition that has not been stabilized or against any employee because the employee reports a violation of an EMTALA requirement. Additionally, individuals suffering personal harm as a direct result of a violation may bring civil action against the hospital for damages for personal injury under the law of the State in which the hospital is located. Medical facilities suffering financial loss as a direct result of a participating hospital’s violation may bring a civil action against the hospital for financial loss under the law of the State in which the hospital is located. Filing a civil action is limited to a period of 2 years after the date of the alleged violation. There is no CMS, QIO, or OIG involvement in any private civil actions.