Shields and other researchers have repeatedly flagged concerns 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.

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

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.