{"id":34540,"date":"2025-09-24T05:17:08","date_gmt":"2025-09-24T05:17:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/34540\/"},"modified":"2025-09-24T05:17:08","modified_gmt":"2025-09-24T05:17:08","slug":"for-profit-hospitals-continue-to-violate-emtala-with-few-repercussions-propublica","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/34540\/","title":{"rendered":"For-Profit Hospitals Continue to Violate EMTALA With Few Repercussions \u2014 ProPublica"},"content":{"rendered":"

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories<\/a> as soon as they\u2019re published.<\/p>\n

As the share of U.S. adults receiving mental health care treatment steadily grows<\/a>, for-profit companies are playing an increasingly important role.<\/p>\n

More than 40% of inpatient mental health beds were operated by for-profit entities as of 2021, according to unpublished data from Morgan Shields, an assistant professor at Washington University in St. Louis who studies quality in behavioral health care. That\u2019s up from about 13% in 2010<\/a>. (The number of mental health beds held relatively constant during that time.)<\/p>\n

Experts tie this growth to provisions of the Affordable Care Act, which made mental health care an essential health benefit that all insurance plans are required<\/a> to cover.<\/p>\n

Before the law, millions of Americans lacked meaningful mental health care coverage by their insurers \u2014 if they had any coverage at all. That changed with the law\u2019s passage in 2010. Three years later, the Obama administration went further, issuing rules that require plans to pay more<\/a> for mental health care, and to pay for it as long as patients need it. (Some plans had previously imposed hard caps on the number of days they would cover.)<\/p>\n

Wider access to and increased reimbursement of mental health services piqued the interest of for-profit corporations, said Eileen O\u2019Grady, who until recently served as program director at the Private Equity Stakeholder Project, a nonprofit organization that researches the industry.<\/p>\n

\u201cInvestors in for-profit entities see that as an opportunity to make money,\u201d she said, \u201cin a space that had not historically been seen as super profitable.\u201d<\/p>\n

Shields and other researchers have repeatedly flagged<\/a> concerns<\/a> about lower quality of care at mental health facilities owned by for-profit corporations, in part due to efforts to cut staff and reduce costs. Companies have defended the quality of care they provide.<\/p>\n

ProPublica reported Monday that over 90 psychiatric hospitals<\/a> across the country have violated the Emergency Medical Treatment and Labor Act in the past 15 years. The vast majority of them \u2014 around 80% \u2014 are owned by for-profit corporations.<\/p>\n

Yet only a handful have faced any consequences from either the U.S. Centers for Medicare and Medicaid Services or the inspector general of the Department of Health and Human Services, both of which are responsible for regulating the law. In the rare cases when hospitals have faced fines, the penalties have been trivial compared to the earnings of each for-profit hospital chain, the investigation found.<\/p>\n

According to ProPublica\u2019s analysis of CMS data, about half of all the hospitals cited were owned by just two corporations \u2014 Universal Health Services and Acadia Healthcare \u2014 which together operate hundreds of inpatient and outpatient behavioral health facilities, in addition to psychiatric hospitals. (UHS made nearly $16 billion in revenue last year, and Acadia collected more than $3 billion.)<\/p>\n

From 2010 through the second quarter of this year, 34 of UHS\u2019 psychiatric hospitals had been cited with EMTALA violations. Two, Brentwood Behavioral Healthcare<\/a> of Mississippi and Three Rivers Behavioral Health<\/a> in South Carolina, settled with the HHS inspector general for a total of $375,000.<\/p>\n

In its May 9 enforcement action<\/a> against Brentwood, the inspector general of HHS found that, in June 2021, the hospital\u2019s interim CEO directed staff to refuse to accept seven patients from other facilities under the pretense that the facility \u201cdid not have the capacity\u201d to treat them. \u201cIn each instance, however, Brentwood had the capacity,\u201d an inspector general press release accompanying the enforcement action said, \u201cbut refused the transfer because the individual needing treatment was uninsured.\u201d<\/p>\n

UHS spokesperson Jane Crawford said the company has 134 facilities that are subject to EMTALA. \u201cWhile there have been isolated citations associated with technical EMTALA compliance over the 15-year time period in question at some of our facilities, over 75% of UHS Behavioral Health (BH) facilities did not have any EMTALA citations during this time period,\u201d Crawford said. \u201cAs such, the narrative or belief that UHS\u2019 facilities as a whole do not comply with EMTALA or attempts to circumvent its requirements is inaccurate and incorrect.\u201d<\/p>\n

In a separate statement, she said the company\u2019s psychiatric hospitals \u201cdo not select patients based upon insurance status or ability to pay. All UHS facilities are committed to complying with their EMTALA obligations as applicable and provide the requisite care and treatment to all patients who present to the facility regardless of ability to pay.\u201d<\/p>\n

As for what happened at Brentwood, Crawford said that the hospital \u201cinadvertently violated rules and regulations\u201d due to \u201cpoor internal communication and process failure in a one-month period of time.\u201d Brentwood \u201cpromptly revised its practices to address any such future concerns and has not had any EMTALA related issues since that time,\u201d she added.<\/p>\n

On the events at Three Rivers, Crawford said that of the 11 patients that CMS said it denied to accept for transfer, citations related to 10 of them were ultimately \u201crescinded as it was determined that EMTALA did not apply to those patients.\u201d She added that \u201cat no time did Three Rivers fail to respond or accept a fax request based upon any prospective patient\u2019s insurance status or ability to pay.\u201d CMS did not respond to requests to clarify whether the citations were rescinded, but they remain on its website.<\/p>\n

Inspectors have cited 12 Acadia hospitals for EMTALA violations since 2010. However, only one \u2014 Park Royal Hospital<\/a> in Florida \u2014 has been fined by the inspector general; in 2019, the agency fined the hospital just over $52,000.<\/p>\n

\u201cOur goal is always to provide the best quality care to anyone seeking treatment at one of our facilities, and we take our compliance obligations very seriously,\u201d Acadia spokesperson Tim Blair said in an email. He did not respond to subsequent questions about quality of care at Park Royal.<\/p>\n

Dr. Jane Zhu, an associate professor of medicine at Oregon Health and Science University, said decisions made by for-profit psychiatric hospitals may be driven by financial interests. Denying care to patients without insurance or with lower-paying forms of insurance can help increase profits, Zhu said.<\/p>\n

Those same financial incentives may drive for-profit hospitals to turn away more complicated patients \u2014 such as those who are aggressive or violent while in the throes of a mental health crisis, Zhu added. In these situations, hospitals can save on staffing and other costs if they admit healthier patients and avoid patients with the most severe psychiatric needs \u2014 a tactic she called \u201ccream-skimming.\u201d<\/p>\n

Both CMS and the HHS inspector general declined to comment on why psychiatric hospitals owned by for-profit corporations have so infrequently faced consequences for EMTALA violations.<\/p>\n

Federal law caps the amount that the HHS inspector general can fine for EMTALA violations, an agency spokesperson said. In 2024, that amount was about $66,000 per violation for hospitals with fewer than 100 beds, and $133,000 per violation for hospitals with more than 100 beds. (The figure increases annually for inflation.)<\/p>\n

Since 2010, in four of the five cases in which the agency settled with psychiatric hospitals for EMTALA violations, the amounts were well below the maximum allowable. The inspector general\u2019s office declined to comment why.<\/p>\n

Former staffers from both CMS and the inspector general\u2019s office said that the lack of consequences for EMTALA violations may be emboldening hospitals to turn away patients that could hurt their bottom line.<\/p>\n

\u201cThere are a lot of CEOs who will take that risk \u2014 they say, \u2018Yeah, we know we dumped that patient,\u2019 or, \u2018They\u2019re not going to fine us anyhow,\u2019\u201d said a former CMS official focused on EMTALA who spoke on the condition of anonymity because of ongoing work in the industry.<\/p>\n

And even in the cases when facilities do face fines, the sums have been minimal compared to chains\u2019 bottom lines.<\/p>\n

\u201cHospitals may see those small-dollar figures as just the cost of doing business,\u201d said a former senior official in the HHS inspector general\u2019s office who spoke on the condition of anonymity for fear of affecting future job opportunities. \u201cThey weren\u2019t seen as a particular deterrent.\u201d<\/p>\n

U.S. Rep. Frank Pallone Jr., D-N.J., ranking member of the House Energy and Commerce Committee, said ProPublica\u2019s findings are cause for concern.<\/p>\n

\u201cIn the face of a large mental health crisis, we should be doing more, not less, to ensure people have access to the care and treatment they need,\u201d he said in a statement.<\/p>\n

\u201cMedicate Him and Ship Him Out\u201d<\/p>\n

Perimeter Healthcare is one such company whose growth came years after passage of the ACA. In September 2016, Perimeter \u2014 backed by $8 billion private equity firm Ridgemont Equity Partners \u2014 acquired another company and, with it, five residential treatment facilities and three psychiatric hospitals.<\/p>\n

By May 2019, Perimeter acquired its six and seventh hospitals. The hospitals\u2019 former parent company, SAS Healthcare, was indicted<\/a> months earlier for violating the Texas mental health code. It later pleaded guilty to one count and paid a $200,000 fine; the county dropped the other charges<\/a>.<\/p>\n

The hospitals in Dallas and Arlington aimed to \u201cserve as the gold standard for inpatient psychiatric care,\u201d Rod Laughlin, Perimeter\u2019s founder, said in a press release announcing the acquisition<\/a>.<\/p>\n

But within years of Perimeter taking over, the Dallas hospital again was in the spotlight.<\/p>\n

In August 2023, CMS found that Perimeter Behavioral Hospital of Dallas violated EMTALA in four ways when staff refused<\/a> to examine a patient who had tried to kill himself. (\u201cIf that is the patient I am thinking of, he can\u2019t be here,\u201d a hospital staff member told a police officer at the time, according to CMS records. \u201cAll we can do is medicate him and ship him out.\u201d) Under the law, hospitals are required to screen and stabilize all emergency patients before discharging them.<\/p>\n

And less than a year later, at the same hospital, staff pushed for another patient to be transferred elsewhere after he started flipping chairs.<\/p>\n

That led to a standoff between staff and police as the patient slammed against the walls, trying to escape.<\/p>\n

\u201cLegally we can\u2019t touch him because he is not our patient,\u201d a hospital staff member told an officer during the exchange, according to CMS records<\/a>.<\/p>\n

With that, the officer called another officer, who asked hospital staff if there was \u201ca particular reason\u201d they were refusing to admit the patient.<\/p>\n

\u201cThis individual here is beyond our ability to treat\u201d due to his \u201cextreme aggression,\u201d a staff member responded. \u201cWe can\u2019t manage him.\u201d<\/p>\n

\u201cUnder EMTALA since he is on your grounds EMTALA says you guys are responsible \u2014 so we are having a disagreement here,\u201d the second officer responded. \u201cI guess,\u201d the officer added, \u201cmy next call is to CMS.\u201d<\/p>\n

\u201cIt is not even necessary to call CMS,\u201d the hospital staff member said, \u201cbut feel free to do that.\u201d<\/p>\n

Eventually, CMS was called. And some two weeks after the incident, the agency found that the hospital had violated EMTALA in three ways, including failing to provide even the most basic care through a medical examination of the patient \u2014 beyond just eyeballing him.<\/p>\n

When hospitals breach the law, they are required to send plans to CMS detailing how they will avoid violating EMTALA in the future. Plans of correction filed by Perimeter Behavioral Hospital of Dallas said the hospital would revise some of its materials, including training slides, a test, a self-attestation form used in staff training and a medical screening form for patients. Officials also said they would monitor compliance with the law by reviewing patient logs daily. But the hospital also noted multiple instances in which officials believed \u201cno changes were needed\u201d to its policies.<\/p>\n

Beyond responding to CMS with these plans, the hospital did not face consequences from the agency, or from the HHS inspector general for either set of findings. The agencies have not responded to questions about the lack of follow-up in the Perimeter Dallas cases.<\/p>\n

Perimeter Healthcare and Ridgemont Equity Partners did not respond to requests for comment.<\/p>\n

<\/p>\n

\"\"<\/p>\n

\n Psychiatric Hospitals Turn Away Patients Who Need Urgent Care. The Facilities Face Few Consequences.\n <\/p>\n

<\/a><\/p>\n

Lately, lawmakers and regulators have expressed particular alarm about health facilities owned by private-equity companies \u2014 like Ridgemont Equity Partners \u2014 which typically take control of a business for a relatively short time, restructure it, and resell it at a profit.<\/p>\n

Data on for-profit health facilities, in general, shows worse results for both hospitals<\/a> and nursing homes<\/a> after they are acquired by private equity firms. A January report<\/a> by HHS, before the end of the Biden administration, attributed quality differences in part to private-equity firms\u2019 tendency to \u201cdramatically reduce the operational costs\u201d of health care facilities.<\/p>\n

Recent research<\/a> demonstrates that private equity is playing an increasing role in psychiatric hospitals, and that has some federal officials worried. In January, the Senate Budget Committee released a bipartisan congressional staff report<\/a> investigating private equity\u2019s growing presence in health care.<\/p>\n

Officials from the Healthcare Private Equity Association, the trade group that represents medical facilities owned by over 100 investment firms, did not respond to requests for comment.<\/p>\n

\u201cInstead of helping families, billionaire corporations are denying sick patients legally protected emergency care to turn healthy profits,\u201d Sen. Jeff Merkley, D-Ore., ranking member of the Senate Budget Committee, said in a statement to ProPublica.<\/p>\n

\u201cThis unchecked corporate greed is leading to worse outcomes for patients,\u201d Merkley added, \u201cparticularly those who struggle with mental health crises.\u201d<\/p>\n

This reporting was supported by the McGraw Center for Business Journalism at CUNY\u2019s Newmark Graduate School of Journalism, the Fund for Investigative Journalism and the National Institute for Health Care Management Foundation.<\/p>\n","protected":false},"excerpt":{"rendered":"ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as…\n","protected":false},"author":2,"featured_media":34541,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[163,85,46,522,523],"class_list":{"0":"post-34540","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-mental-health","8":"tag-health","9":"tag-il","10":"tag-israel","11":"tag-mental-health","12":"tag-mentalhealth"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/34540","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=34540"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/34540\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/34541"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=34540"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=34540"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=34540"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}