An EMTALA violation occurs when a hospital that participates in Medicare fails to screen, stabilize, or properly transfer someone who comes to the emergency department with a medical emergency. The law, passed in 1986, was specifically designed to stop “patient dumping,” the practice of turning away or transferring patients because they were uninsured or couldn’t pay. Any hospital that accepts Medicare (which is nearly all of them) must follow EMTALA regardless of a patient’s insurance status, citizenship, or ability to pay.
What EMTALA Requires Hospitals to Do
EMTALA creates three core obligations. First, when anyone comes to the emergency department requesting care, the hospital must provide a medical screening exam to determine whether an emergency medical condition exists. This includes active labor. The screening can’t be delayed to ask about insurance or collect payment.
Second, if the screening reveals an emergency condition, the hospital must provide stabilizing treatment. “Stabilized” means the patient’s condition won’t materially deteriorate during or after a transfer or discharge.
Third, if the hospital can’t stabilize the patient with its own resources, it must arrange an appropriate transfer to a facility that can. That transfer comes with its own set of strict requirements.
Actions That Count as Violations
Violations fall into several categories, and some are less obvious than outright refusal of care.
- Refusing to screen. Turning a patient away from the emergency department before performing a medical screening exam, whether explicitly or by creating conditions that discourage the patient from waiting (like quoting high costs before any evaluation).
- Inadequate screening. Performing a screening that doesn’t meet the hospital’s own standard for similar symptoms. If chest pain in an insured patient gets an EKG and lab work, the same complaint in an uninsured patient must receive the same workup.
- Failing to stabilize. Discharging or transferring a patient with an identified emergency condition before their condition is stabilized, without meeting the legal requirements for an unstable transfer.
- Improper transfers. Moving an unstabilized patient to another hospital without a physician certifying that the medical benefits of the transfer outweigh the risks, without sending medical records, without confirming the receiving hospital will accept the patient, or without using appropriate transport equipment and personnel.
- Failing to accept transfers. A hospital with specialized capabilities (like a burn unit or trauma center) that refuses to accept a transfer when it has the capacity to treat the patient.
Research from Denver Health, a large safety-net hospital, documented that patients with emergency conditions, many of them uninsured, continued to arrive after being denied care or receiving incomplete care at other facilities. Patient dumping didn’t disappear after EMTALA passed. It became more subtle.
Transfer Rules for Unstable Patients
Transferring a patient who hasn’t been stabilized is one of the most common areas where hospitals run into trouble. EMTALA allows it only under narrow circumstances: the patient (or their representative) requests the transfer after being informed of the risks, or a physician signs a written certification that the benefits of the transfer outweigh the risks. If the responsible physician isn’t physically present in the emergency department, a qualified medical professional can sign the certification, but the physician must countersign it promptly.
Beyond the certification, the hospital must provide treatment to minimize the risks of the transfer, send all pertinent medical records to the receiving facility, confirm that the receiving hospital agrees to accept the patient, and ensure the transfer uses qualified personnel and medically appropriate life support equipment. Missing any one of these steps can constitute a violation.
Penalties for Violations
Hospitals and individual physicians face civil monetary penalties for EMTALA violations. Hospitals with more than 550 beds can be fined up to $5,500 per day of noncompliance. Hospitals with 31 to 550 beds face fines of $10 per bed per day, and those with 30 or fewer beds can be fined up to $300 per day. Beyond fines, hospitals can lose their Medicare provider agreement entirely, which for most facilities would be financially devastating.
Individual physicians who negligently violate EMTALA or sign false certifications for transfers can also face civil penalties and exclusion from Medicare. Patients harmed by a violation can file civil lawsuits against the hospital, though they cannot sue the federal government or individual doctors under EMTALA itself.
Required Signage and Patient Rights
Hospitals are required to post signs explaining patients’ EMTALA rights in the emergency department and in any area where patients wait for, or receive, emergency examination and treatment. These signs must be placed where they’re likely to be noticed by everyone entering the emergency department, including entrance areas, admitting desks, waiting rooms, and treatment areas. If you’ve been to an ER, you’ve likely seen one of these posted near the check-in window.
How to Report a Suspected Violation
You can file an EMTALA complaint through two channels: contacting the State Survey Agency in the state where the hospital is located, or submitting an online form through CMS. Complaints can be filed anonymously. You’ll need to provide the hospital name, what happened, and the date of the incident.
Filing quickly helps preserve the details and strengthens any potential legal action you might pursue separately. If you provide your email on the online form, you’ll receive confirmation that the federal government received your complaint. The federal government and state agencies work together to investigate, and the process typically takes weeks to months depending on the complexity. If you provide contact information, you’ll receive a summary of the investigation’s findings. Investigators may also reach out to patients and others identified in hospital records, even if the complaint was filed anonymously.
EMTALA and State Abortion Restrictions
Since 2022, EMTALA has become central to the legal conflict between federal emergency care requirements and state abortion bans. CMS issued guidance stating that if a physician determines an abortion is the stabilizing treatment necessary to resolve a pregnant patient’s emergency medical condition, the hospital must provide it, and any state law to the contrary is preempted by federal law.
This created a direct clash with states like Idaho, whose law allowed abortions only to prevent a patient’s death. EMTALA’s standard is broader: it covers conditions that pose serious risks to health, including loss of fertility, even when the patient’s life isn’t immediately threatened. In June 2024, the Supreme Court dismissed the case (Moyle v. United States) without ruling on the merits, leaving a lower court injunction in place that prevents Idaho from enforcing its abortion ban when terminating a pregnancy is needed to prevent serious health harms. The broader legal question of whether EMTALA preempts state abortion restrictions remains unresolved and could return to the courts.