Hospital building

The Centers for Medicare and Medicaid Services have issued new fines to two hospitals for violations of price transparency requirements issued Jan. 1, 2021.

Since Jan. 1, 2021, U.S. hospitals are required by law to publicly post their prices online. But for some it has been impossible to find them or confirm their accuracy. C.M.S. has come under fire for lax enforcement of the transparency regulations. Before these two new fines, only two other fines had been issued for non-compliance with the rules, which came into effect Jan. 1, 2021.

“C.M.S. has issued fines to two hospitals for alleged price transparency violations,” Andrew Cass writes of the new fines over at Becker’s Hospital Review. “Rochester, N.H.-based Frisbie Memorial Hospital was issued a $102,660 fine April 19. Wichita Falls, Texas-based Kell West Regional Hospital was issued a $117,260 fine that same day.  The fines are the third and fourth C.M.S. has issued to hospitals for violating federal price transparency laws.”

“According to the notice C.M.S. sent to Frisbie, the agency first issued a warning notice to the hospital on Aug. 25, 2021. It reviewed Frisbie’s machine-readable file again on Oct. 24, 2022, and determined the hospital remained noncompliant . …. C.M.S. issued a corrective action plan request Nov. 2.  C.M.S. said. … Frisbie has not submitted a corrective action plan and has not responded to the agency’s attempts to contact the hospital.

“According to the notice C.M.S. sent to Kell West, the agency issued a warning notice to the hospital on July 27, 2022. After another review, C.M.S. issued a corrective action plan request on Nov. 7. Kell West submitted a plan on Dec. 22 with a proposed completion date of Feb. 15. C.M.S. requested a revision Jan. 6 and the revised plan was approved by the agency Jan. 25. 

The hospitals fined before were Northside Hospital of Atlanta, which was fined $883,180, and Northside Hospital Cherokee in Canton, Ga., which was fined $214,320. 

Compliance has been widely known to be lackadaisical, leading to expectations that enforcement would not be serious. Hospitals have pleaded that the task is hard, and that their work during the pandemic needed to take precedence over this kind of effort. But compliance has gradually improved overall.

C.M.S. said in an April 26 news release that it had issued more than 730 warnings and 269 corrective action plan requests to hospitals.

Changes to enforcement process

In that April 26 release, C.M.S. also set out some changes to its enforcement process.

  1. Requiring C.A.P. [corrective action plan] completion deadlines. C.M.S. will continue to require hospitals that are out of compliance with the hospital price transparency regulation to submit a C.A.P. within 45 days from when C.M.S. issues the C.A.P. request. C.M.S. will also now require hospitals to be in full compliance with the hospital price transparency regulation within 90 days from when C.M.S. issues the C.A.P. request, rather than allowing hospitals to propose a completion date for C.M.S. approval which can vary. …
  2. Imposing C.M.P.s [civil monetary penalties] earlier and automatically.  Currently, C.M.S. does not impose automatic C.M.P.s for failure to submit a requested C.A.P. or failure to come into compliance within 90 days from when a C.A.P. request is issued. C.M.S. will now automatically impose a C.M.P. on hospitals that fail to submit a C.A.P. at the end of the 45-day C.A.P. submission deadline. Before imposing the C.M.P., C.M.S. will re-review the hospital’s files to determine whether any of the violations cited in the C.A.P. request continue to exist and, if violations are found, impose a C.M.P.. …
  3. Streamlining the compliance process. For hospitals that have not made any attempt to satisfy the requirements (i.e., those that have not posted any machine-readable file or shoppable services list/price estimator tool), C.M.S. will no longer issue a warning notice to the hospital and will instead immediately request that the hospital submit a C.A.P. Currently, C.M.S. does not issue C.A.P. requests without first issuing a warning notice.”

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...