This summer, the United States Centers for Medicare and Medicaid Services (CMS) issued multiple civil monetary penalty (CMP) notices for violations of the hospital price transparency rule, bringing the total number of CMPs issued for these violations to fourteen. Three CMPs were issued in July (two are under review), five CMPs were issued in August, and two CMPs were issued in September.
As we’ve previously written, as of January 1, 2021, hospitals are required to publish five types of standard charges for items and services in certain formats, easily accessible to patients. If a hospital is non-compliant with the rule, CMS can: issue a warning letter, request a Corrective Action Plan (CAP), and/or impose a CMP on the hospital. Often, when a CMP is issued, it is because the hospital has either failed to submit a CAP within the timeframe or fails to comply with the terms of the CAP submitted after 90 days. The maximum daily CMP depends on the number of beds reported by the hospital in its most recently settled Medicare cost report: $300 per day for hospitals with 30 beds or less; $310-$5,500 per day for hospitals between 31-550 beds; and $5,500 per day for a hospital with more than 550 beds.
July CMPs
The July CMPs were issued to Falls Community Hospital and Clinic ($70,560), Fulton County Hospital ($63,900 – currently under review), and Community First Medical Center ($847,740 – currently under review).
Violations for the July CMPs ranged from failure to make public a machine-readable file containing a list of all standard charges for items and services to failure to update the standard charge information at least once per year to failure to provide a consumer-friendly list of standard charges available online.
August CMPs
The August CMPs were issued to Hospital General Castaner ($101,400), Samaritan Hospital – Albany Memorial Campus ($56,940), Doctors’ Center Hospital Bayamon ($102,200), Betsy Johnson Hospital ($99,540), and UF Health North ($979,000).
Violations for August CMPs were similar to the July violations, including failure to provide an online machine-readable file containing a list of all standard charges for items and services to failure to make available a consumer-friendly list of standard charges for a limited set of shoppable services to failure to include the required data elements in the list of standard charges for shoppable services. Additionally, one hospital was cited for failure to follow the naming convention required by CMS for the comprehensive machine-readable file.
September CMPs
At the time of writing this article, only two CMPs had been issued in September 2023 – one for Holy Cross Hospital ($325,710) and one for Saint Elizabeth’s Hospital ($677,440).
Violations for these CMPs were similar to the July and August violations, including failure to make public a machine-readable file of all standard charges for all items and services online and failure to make available a consumer-friendly list of standard charges for a limited set of shoppable services.
Hospitals have sixty calendar days from the date of the CMP notice to pay the CMP, or thirty calendar days from the date of the CMP notice to appeal the CMP determination and request a hearing before an Administrative Law Judge of the Department of Health and Human Services Departmental Appeals Board.