Inpatient Facility Coding & Compliance Alert

Question: What is meant by “patient dumping”? Is this something auditors will be looking for?

Delaware Subscriber

Answer: “Patient dumping” is definitely a serious offense, and could mean penalties or suspension of a hospital’s Medicare provider agreement at the worst.

Patient dumping refers to a scenario when a hospital, which is otherwise capable of rendering necessary medical services to a patient, decides to transfer him to another facility, or refuses to treat him because the patient is not able to pay. Patient dumping usually occurs in conjunction with EMTALA (Emergency Treatment and Labor Act).

Remember to go by The Social Security Act, § 1867 (42 U.S.C. § 1395dd), which says that when a patient visits the emergency room of a Medicare-participating hospital, the hospital must provide an appropriate medical screening examination to followed by required treatment to stabilize the condition or an appropriate transfer to another medical facility.

Even in the case of a legitimate transfer, the transferring hospital must provide stabilizing treatment so as to maximize the chances of patient recovery. The hospital also needs to ensure that the other receiving hospital agrees to receive the case and has adequate resources and health care professionals to treat the case.

OIG may collect a penalty of $25,000 to $50,000, based on the provider type and size of the hospital, in case of negligence.