The Department of Health and Human Services Office of Inspector General (HHS-OIG) has agreed to settle alleged violations of the Emergency Medical Treatment and Labor Act (EMTALA) patient dumping statute with UAB Medical West, Frankfort Regional Medical Center, and Flowers Hospital.

EMTALA is a federal law that ensures universal access to emergency medical care. EMTALA requires Medicare-participating hospitals to provide a medical screening examination to determine if a patient presenting at the hospital has an emergency medical condition, and provide stabilizing treatment for that condition or arrange an appropriate transfer to another facility if the hospital cannot provide the necessary treatment. Hospitals with specialized capabilities must accept transfers of patients with specialized needs if they have the capacity to provide treatment. These requirements apply to all individuals presenting at a hospital, regardless of their insurance status or ability to pay.

Frankfort Regional Medical Center

Frankfort Regional Medical Center (FRMC) was investigated by HHS-OIG after self-reporting a potential EMTALA violation that occurred in June 2022. A patient presented at the FRMC emergency department via ambulance, complaining about heat exhaustion after working in a hot factory for seven hours. The patient complained about a severe frontal headache, nausea, and had projectile vomited in the ambulance en route to the hospital. The patient rated his headache as an 8 on the 1-10 scale, had clammy skin, and had vomiting/dry heaving. Diagnostic blood work revealed the patient had hyponatremia (low blood salt), hypokalemia (low blood potassium), and mild dehydration, and the physician’s notes stated he was tachycardic.

The ED physician went to speak with the patient, who was upset, and he was allowed to go back to sleep. Two hours later, the patient was difficult to arouse, lethargic, and bradycardic, and his respiration rate was slowing. The ED staff were unsuccessful in trying to arouse the patient with ammonia salts. The patient was provided with Narcan by the ED physician, who suspected a possible drug overdose. The patient then got upset and started to walk around the ED. The police department was called to arrest the patient for trespassing.

The patient sat down in an ED hallway with his arms crossed and head down, and was unresponsive to the ED staff and was no longer verbal. The ED physician cleared the patient to be discharged to jail with instructions for adult dehydration and a clinical note of a drug overdose. Within 24 hours, the patient was admitted to another hospital and received treatment for heat exhaustion. HHS-OIG determined EMTALA had been violated, and the case was settled with a $110,000 financial penalty.

UAB Medical West

UAB Medical West is a Birmingham, AL-based health system that operates a 200-bed UAB Medical West Hospital and numerous primary care facilities in and around Birmingham. UAB Medical West was investigated over a potential EMTALA violation following a complaint about an alleged failure to provide stabilizing treatment to a patient with an emergency medical condition.

HHS-OIG investigated and determined that in May 2023, a patient who presented at the freestanding UAB Medical West Emergency Department (ED) was discharged from the hospital without appropriate treatment, with an instruction to drive to another hospital for a consultation with a urologist and to get stabilizing treatment. The patient had presented at the ED with acute urinary retention – a medical condition that requires immediate medical attention.

Under EMTALA, UAB Medical West was required to provide stabilizing treatment. While staff at the hospital attempted to catheterize the patient, those efforts were unsuccessful, and the patient was not provided with any pain relief, despite the ED having a urologist on-call and access to urology supplies at its main ED. HHS-OIG and UAB Medical West agreed to settle the alleged EMTALA violation with a $100,000 financial penalty.

Flowers Hospital

Flowers Hospital, a 311-bed hospital in Dothan, Alabama, was investigated over an alleged failure to accept two patients who had been transferred to the hospital to receive specialized medical care, as the hospitals where the patients presented lacked the capabilities to provide appropriate care. Both refused transfers occurred in May 2021.

One patient had presented at the ED of an unrelated hospital following an assault and was determined to have multiple facial fractures, including on both sides of his lower jaw. A transfer was attempted as the hospital did not have an oral maxillofacial surgical (OMFS) specialist. The request was denied by Flowers Hospital, which claimed that its OMFS specialist only treated patients with old fractures, not patients with new traumas.

Another patient presented at the ED of a hospital with severe dental pain, which had been worsening for a week. Since the hospital did not have an OMFS specialist, a transfer was attempted, but was declined by the OMFS specialist because Flowers Hospital was not the closest facility with physicians able to provide the necessary stabilizing treatment. HHS-OIG determined that both refusals violated EMTALA, and the case was settled with a $150,000 financial penalty.

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Before hiring any individual or onboarding a new vendor, healthcare organizations that participate in federal healthcare programs such as Medicare or Medicaid must complete due diligence and check to ensure that the individual or entity is not excluded from participating in federally funded healthcare programs.

The Department of Health and Human Services Office of Inspector General (HHS-OIG) maintains an exclusions list consisting of individuals and entities that have been prohibited from participating in federal healthcare programs. Individuals and entities are added to the List of Excluded Individuals and Entities (LEIE) after being found guilty of fraud, abuse, or neglect, although they may be added to the list for other reasons at the discretion of HHS-OIG.

Failure to check the LEIE and subsequently billing federal healthcare programs for products or services provided by an excluded individual or entity can result in a significant fine. In addition to pre-engagement checks of the database, healthcare organizations must conduct regular checks of the LEIE for existing employees, contractors, and vendors. All checks must be documented to maintain an audit trail.

Free Webinar on Sanctions and Exclusions Compliance

Readers of the HIPAA Journal are invited to attend a free webinar, where they will be able to hear from leading compliance experts who will give their expert advice about implementing and maintaining an effective screening program that goes beyond the basic requirements to include establishing and managing conflict of interest programs.

The webinar – The Complete Exclusion Screening Playbook: From Sanctions to Conflicts of Interest – will take place on Tuesday, September 9, 2025. You can find out more and register for the event here.

Recent LEIE additions and Financial Penalties

HHS-OIG has recently announced four new additions to the LEIE, and one financial penalty for a healthcare provider for employing an excluded individual and billing federal healthcare programs for products or services provided by that individual.

• Kidspeace National Centers of New England, Inc., in Ellsworth, Maine, was discovered to have employed an excluded speech pathologist. In this case, the individual was not employed directly, but through a contractor. The alleged violation was settled with HHS-OIG on July 31, 2025, with a $44,736.78 financial penalty.
• Brant Jolly, of Fayetteville, Arkansas, has been excluded from participating in federally funded healthcare programs for 10 years for violating the False Claims Act by causing the submission of false claims to Medicare for lab tests that were either never ordered, never rendered, or involved deceased beneficiaries.
• Nirmal Mulye, PhD, based in Miami, Florida, was added to the LEIE by HHS-OIG for defaulting on payment obligations. Dr. Mulye had previously founded a company that was determined to have underpaid Medicaid rebates, then defaulted on his payment obligations under an active settlement agreement. Dr. Mulye will remain on the LEIE until reinstated by HHS-OIG after curing the default.
• Andres Gomes, MD, of Puerto Rico, defaulted on his payments under a False Claims Act settlement agreement with the Department of Justice and HHS-OIG. The settlement agreement resolved allegations that Dr. Gomes did not pay proper remuneration to physicians for patient referrals to clinics for the surgical treatment of peripheral arterial disease. Dr. Gomes will remain on the LEIE until he cures the default.

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