"The Hospital failed to provide a medical screening examination (MSE) that was, within reasonable clinical confidence, sufficient to determine whether or not an Emergency Medical Condition (EMC) existed," according to the report of the inspection conducted between May 10 and 12. The inspectors based their findings on emergency department logs, review of medical records and policies, and interviews with patients, patient representatives and staff.

The IHS in a statement on Monday said it has already begun addressing the issues and has instituted changes including "new leadership, expanded oversight, staff retraining and policy changes."

CMS handed down funding cutoff deadlines earlier this year to IHS-run hospitals on the Pine Ridge and Rosebud Indian Reservations in South Dakota after substandard conditions were uncovered during inspections. Those facilities agreed to last-chance remediation plans in April so they could continue billing Medicare and Medicaid.

Before that pair of facilities came under scrutiny, the IHS-administered hospital on Nebraska's Winnebago Reservation was the subject of "immediate jeopardy" findings during a survey last May.