An EMTALA violation happens when a Medicare-participating hospital with an emergency department fails to screen, stabilize, or properly transfer someone who comes in seeking emergency care. The Emergency Medical Treatment and Active Labor Act sets those three duties, and breaking any of them can cost a hospital up to $136,886 per violation, cost an on-call physician the same, and in serious cases end a hospital’s Medicare funding altogether. The most common violations fall into a handful of recognizable patterns.
When the Law Applies
EMTALA obligations start the moment a person arrives at a covered hospital and someone requests examination or treatment on their behalf. “Hospital property” under federal guidelines covers the whole main campus, including parking lots, sidewalks, and any hospital-owned building within 250 yards of the main facility. Insurance status, immigration status, ID, and ability to pay are irrelevant to whether the duty exists.
Failure to Provide a Medical Screening Examination
The screening duty is where most violations occur. Every person who comes to the ED and requests care must get a medical screening examination designed to determine whether an emergency medical condition exists, using the full capability of the department, including labs, imaging, and other routinely available services.
Only staff formally designated in the hospital’s bylaws or internal rules as qualified medical personnel can perform the screening. When a registration clerk or security guard decides who looks sick enough to be seen, the hospital has substituted an administrative judgment for a medical one. That is a textbook violation.
Other frequent screening violations:
- Holding up the screening to ask about insurance or method of payment. The statute explicitly prohibits this.
- Making uninsured patients wait significantly longer than insured patients with similar complaints, which amounts to a different, inferior screening process based on finances.
- Letting non-medical staff turn patients away at triage before any qualified person evaluates them.
The screening does not have to be perfect. It has to be consistent. If a hospital routinely orders a CT scan for patients complaining of the worst headache of their life but skips the scan for an uninsured patient with the same complaint, that inconsistency is the violation.
Failure to Stabilize Before Discharge or Transfer
When the screening reveals an emergency medical condition, the hospital has to stabilize the patient before letting them leave. Under the statute, “stabilized” means that, within reasonable medical probability, no material deterioration of the condition is likely to result from or occur during the transfer. For a pregnant woman having contractions, stabilization means delivery, including the placenta.
Sending home a patient who is actively bleeding, showing signs of stroke, or having a cardiac event because the hospital lacks a specialist is not a defense. The hospital must do everything within its existing staff and facilities to stabilize the patient first. Only after stabilization, or through a properly executed transfer, can the patient go.
Improper Transfers
Transferring an unstable patient is allowed, but only when specific conditions are met. A physician must sign a written certification that the medical benefits of the transfer outweigh the risks. Beyond that certification, all of the following must be true:
- The receiving hospital agrees to accept the patient and has the capacity to treat the condition.
- All relevant medical records and documentation travel with the patient.
- Transport uses qualified personnel and appropriate medical equipment, including life-support measures when needed.
- The transferring hospital provides whatever stabilizing treatment it can before and during the transfer to minimize risk.
Moving an unstable patient for economic reasons, without meeting these requirements, is the classic “patient dumping” scenario the statute was written to prevent.
Specialized Hospitals That Refuse Incoming Transfers
EMTALA also regulates the receiving end. A hospital with specialized capabilities, such as a burn unit, trauma center, or neonatal intensive care unit, cannot refuse an incoming transfer of a patient who needs those resources if it has the capacity to treat them. Turning away a critically burned patient because the receiving burn center does not want the financial burden is a violation by the receiving hospital.
On-Call Physician Refusals
Hospitals with emergency departments must maintain a list identifying individual on-call physicians by name. Group practice names are not enough.
When the ED physician determines that a patient needs a specialist’s in-person assessment, the on-call physician must show up within a reasonable time. The most frequent violation here is refusal: an on-call surgeon telling the ER to “just transfer the patient” rather than coming in to operate. The statute addresses this directly. If the on-call physician fails or refuses to appear, the physician who then authorizes the transfer is protected from penalties. The on-call physician who refused is not. That physician faces the same civil monetary penalties as the hospital, and for gross, flagrant, or repeated violations can be excluded from Medicare and Medicaid entirely.
Psychiatric Emergency Violations
EMTALA’s screening and stabilization requirements apply in full to psychiatric emergencies. The statute’s definition of an emergency medical condition includes psychiatric disturbances and symptoms of substance abuse when the severity is such that the absence of immediate attention could seriously jeopardize the patient’s health. CMS guidance is explicit that a patient expressing suicidal or homicidal thoughts, if determined dangerous to themselves or others, has an emergency medical condition under EMTALA.
Proper screening for behavioral health symptoms requires two steps: a medical evaluation to rule out organic causes, and a psychiatric examination to determine whether a psychiatric emergency exists. Skipping either step violates the law.
Stabilization for a psychiatric patient means the patient is protected and prevented from harming themselves or others. A hospital cannot discharge a suicidal patient to the waiting room or parking lot because no psychiatric bed is available. If the hospital has inpatient capacity, it is expected to admit. CMS treats “capacity” broadly. It includes whatever the hospital customarily does to accommodate patients beyond usual occupancy, such as moving patients between units, calling in additional staff, or borrowing equipment. A hospital claiming lack of capacity while holding open beds for other reasons risks a citation. Leaving a psychiatric patient unmonitored in the ER for hours, sometimes called psychiatric boarding, can itself be a violation if the hospital is withholding stabilizing treatment it could provide.
What EMTALA Does Not Cover
EMTALA is an anti-dumping statute, not a federal malpractice law. It protects against being turned away, undertreated for financial reasons, or moved when you should not have been moved. It does not protect against misdiagnosis or poor-quality care.
If the ER doctor screens you in exactly the same way the hospital screens everyone with your symptoms but misses a fracture on the X-ray, that is potentially malpractice, not an EMTALA violation. Proving an EMTALA screening violation requires showing that the screening you received was different from the hospital’s standard process, not that it failed to catch your condition. An allegation of ER negligence alone does not state an EMTALA claim.
The distinction affects where your case is heard. EMTALA claims go to federal court. If the federal claim is dismissed, the court may decline jurisdiction over a related state malpractice claim, forcing a refile in state court. Getting the legal theory right at the outset saves time and money.
Penalties
CMS investigates EMTALA complaints, often through state survey agencies, and the HHS Office of Inspector General imposes financial penalties. The base statutory amounts are $50,000 per violation for hospitals with 100 or more beds and $25,000 per violation for smaller hospitals, adjusted for inflation each year. As of the most recent 2025 adjustment, the maximums are:
- Hospitals with 100 or more beds: up to $136,886 per violation.
- Hospitals with fewer than 100 beds: up to $68,445 per violation.
- Responsible physicians, including on-call physicians: up to $136,886 per violation.
Physicians who commit gross, flagrant, or repeated violations also face exclusion from Medicare and Medicaid. For a hospital, the most severe consequence is termination of its Medicare provider agreement, which cuts off Medicare and Medicaid reimbursement. Few hospitals survive that.
CMS weighs aggravating factors when setting the penalty, including asking for proof of insurance or payment before screening, causing patient harm, and turning away someone with a true emergency. A hospital that self-reports and takes corrective action before CMS begins investigating may see a reduced penalty.
Private Lawsuits
EMTALA creates a private right of action, but only against the hospital. You cannot sue an individual physician under EMTALA in civil court, even if that physician caused the violation. The physician’s exposure is on the government-enforcement side.
If you suffered personal harm as a direct result of an EMTALA violation, you can recover whatever damages are available for personal injury under the law of the state where the hospital is located, plus any appropriate equitable relief. Because the statute defers to state law, recoveries vary. State damages caps, where they exist, apply.
The deadline is strict. You must file suit within two years of the date of the violation. Missing that deadline forfeits the federal EMTALA claim entirely. Any related state malpractice claim has its own deadline under state law, typically between one and five years.
How to File an EMTALA Complaint
You do not need a lawyer to report a suspected violation. CMS accepts complaints through the state survey agency in the state where the hospital is located, or online through the CMS website. Complaints can be filed anonymously.
Before filing, gather the hospital name, the date and time of the incident, what happened during your visit, and the names of any staff you interacted with. File while the facts are fresh. Using the online form with an email address gets you a federal confirmation, and the federal government and state agencies then coordinate the investigation.
Filing a complaint is separate from filing a lawsuit. The complaint triggers a regulatory investigation that can lead to fines and corrective action plans. A lawsuit seeks personal damages for the harm you suffered. Pursuing one does not block the other, and if you believe you were harmed, consulting an attorney while filing the regulatory complaint covers both tracks.