CMS toughens hospital price transparency enforcement

By Victoria Turner / April 26, 2023

The Centers for Medicare and Medicaid Services is strengthening enforcement of its hospital transparency rule by imposing stricter timelines and levying fines more quickly, the agency announced Wednesday.

Hospital compliance with the requirement that they publicly disclose prices has been mixed, and some facilities have deemed it less onerous to pay civil monetary penalties than to provide publicly available information about their chargemaster prices, their negotiated rates with health insurance companies and their cash prices.

Now, CMS is taking a firmer hand and eliminating flexibilities originally intended to promote compliance. For example, the agency will automatically issue civil monetary penalties against hospitals that fail to provide corrective action plans or remain out of compliance for more than 90 days after submitting such plans.

Under the new policy, hospitals will have a maximum of 90 days to come into compliance after they agree to corrective action plans. CMS also will no longer offer warning notices to facilities that have made no efforts to comply, and instead will immediately demand corrective action plans.

Last year, CMS increased the penalty for a full calendar year of noncompliance to a minimum of $109,500 and maximum of $2 million per hospital.

The agency issued its largest penalty to date last June when it fined Northside Hospital Atlanta $883,000. As of this month, CMS has sent more than 730 warning notices and 269 corrective action plan requests, but has levied civil monetary penalties against just four hospitals, according to the agency.