Calls for Government Watchdog to Investigate Hospitals’ Compliance With Price Transparency Rules and CMS’ Performance as Enforcer

The Federal Hospital Price Transparency Rule aims to improve the affordability of hospital care by promoting price competition and helping Americans know the cost of a hospital item or service before receiving it. Compliance from hospitals is mandatory, as a low compliance level among hospitals would compromise the operational effectiveness of this regulation. Understanding hospitals’ compliance status has important implications for its enforcement effort and effectiveness assessment.

In November 2021, CMS finalized the 2022 Medicare Outpatient Hospital Prospective Payment Rule, which increased civil monetary penalties (CMPs) for hospital noncompliance from a maximum of $109,500 per year to a sliding scale of up to $2 million per year for larger hospitals.

As of January 2022, CMS has issued over 300 warning letters and 98 requests for CMPs for hospitals deemed to be noncompliant. In June 2022, CMS issued CMP notices to two hospitals for failure to comply with the final rule.

The House Committee on Energy and Commerce is calling on the government watchdog, the Government Accountability Office, to investigate how well hospitals are complying with price transparency rules in addition to how well CMS is monitoring and enforcing hospital compliance.

Until there is a higher compliance rate, the government will continue auditing and monitoring for hospitals failing to comply.