The "anti-dumping" provisions under Section 1867 of the Social Security Act have been clarified and strengthened by recent amendments. Medicare-participating hospitals must post signs informing the public of their obligation to examine, treat, and appropriately transfer individuals who request emergency services in the emergency department. Inquiries about an individual's method of payment or insurance source may not delay examination or treatment. Qualified personnel must perform medical screening of all emergency patients, and those to be transferred with emergency medical conditions which have not been stabilized must receive treatment to minimize the risk of transfer. There are stepped-up requirements for informed patient consent and documentation that the medical benefits of a transfer outweigh the risks. In physician-initiated transfers, the receiving hospital must be sent certification by a physician that the benefits of transfer outweigh the risks. Since there is evidence that medically appropriate transfers of persons with emergency medical conditions may actually be underutilized, particularly in rural settings, medical reviewers should avoid an anti-transfer bias.