HCA Holdings 2011 Annual Report Download - page 28

EMTALA
All of our hospitals in the United States are subject to EMTALA. This federal law requires any hospital
participating in the Medicare program to conduct an appropriate medical screening examination of every
individual who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an
emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to
a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists
regardless of an individual’s ability to pay for treatment. There are severe penalties under EMTALA if a hospital
fails to screen or appropriately stabilize or transfer an individual or if the hospital delays appropriate treatment in
order to first inquire about the individual’s ability to pay. Penalties for violations of EMTALA include civil
monetary penalties and exclusion from participation in the Medicare program. In addition, an injured individual,
the individual’s family or a medical facility that suffers a financial loss as a direct result of a hospital’s violation
of the law can bring a civil suit against the hospital.
The government broadly interprets EMTALA to cover situations in which individuals do not actually
present to a hospital’s emergency room, but present for emergency examination or treatment to the hospital’s
campus, generally, or to a hospital-based clinic that treats emergency medical conditions or are transported in a
hospital-owned ambulance, subject to certain exceptions. At least one court has interpreted the law also to apply
to a hospital that has been notified of a patient’s pending arrival in a non-hospital owned ambulance. EMTALA
does not generally apply to individuals admitted for inpatient services. The government has expressed its intent
to investigate and enforce EMTALA violations actively in the future. We believe our hospitals operate in
substantial compliance with EMTALA.
Corporate Practice of Medicine/Fee Splitting
Some of the states in which we operate have laws prohibiting corporations and other entities from
employing physicians, practicing medicine for a profit and making certain direct and indirect payments or
fee-splitting arrangements between health care providers designed to induce or encourage the referral of patients
to, or the recommendation of, particular providers for medical products and services. Possible sanctions for
violation of these restrictions include loss of license and civil and criminal penalties. In addition, agreements
between the corporation and the physician may be considered void and unenforceable. These statutes vary from
state to state, are often vague and have seldom been interpreted by the courts or regulatory agencies.
Health Care Industry Investigations
Significant media and public attention has focused in recent years on the hospital industry. This media and
public attention, changes in government personnel or other factors may lead to increased scrutiny of the health
care industry. Except as may be disclosed in our SEC filings, we are not aware of any material investigations of
the Company under federal or state health care laws or regulations. It is possible that governmental entities could
initiate investigations or litigation in the future at facilities we operate and that such matters could result in
significant penalties, as well as adverse publicity. It is also possible that our executives and managers could be
included in governmental investigations or litigation or named as defendants in private litigation.
Our substantial Medicare, Medicaid and other governmental billings result in heightened scrutiny of our
operations. We continue to monitor all aspects of our business and have developed a comprehensive ethics and
compliance program that is designed to meet or exceed applicable federal guidelines and industry standards.
Because the law in this area is complex and constantly evolving, governmental investigations or litigation may
result in interpretations that are inconsistent with our or industry practices.
In public statements surrounding current investigations, governmental authorities have taken positions on a
number of issues, including some for which little official interpretation previously has been available, that appear
to be inconsistent with practices that have been common within the industry and that previously have not been
challenged in this manner. In some instances, government investigations that have in the past been conducted
under the civil provisions of federal law may now be conducted as criminal investigations.
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