PATIENT DUMPING: Hospitals Caught Between Feds, HMOs
Hospitals are increasingly caught in the middle as federal regulators crack down on "patient dumping" and more managed care plans refuse to pay for out-of-network emergency care, Business Insurance reports. A 1986 federal law prohibits hospitals from "dumping" patients before they are medically stabilized or inquiring about patients' insurance status before providing emergency care. But according to a report by the Office of the Inspector General and HCFA, some hospitals have begun seeking "prior authorization from a patient's primary care physician" or HMO for fear of managed care companies' withholding payment. The OIG/HHS report warns that hospitals "clearly must abide by the [federal] statute in these cases." In addition, Business Insurance reports that federal officials are considering extending the patient dumping law "to hospitals' adjunct operations," such as urgent care centers.
Between a Rock and a Hard Place?
Even worse for hospitals, patient dumping may soon carry stiffer consequences of civil liability as patients gain increased rights to sue for denied care. A case currently being heard by the California Supreme Court argues that because patient dumping is a federal violation, damages should not be limited by the state's $250,000 malpractice cap. The California Medical Association, the California Dental Association and the California Healthcare Association have filed an amicus brief arguing that "if the plaintiffs prevail in voiding" the malpractice cap, trial lawyers will file more patient dumping claims "to bypass the state limits." According to Alison Turner, defendants' attorney in the California case, so far "a handful of federal courts ... and two district courts ... have ruled that state malpractice caps do apply" in patient dumping cases. Business Insurance reports that the California High Court has until April to make its decision on the issue (Ceniceros, 2/15 issue).