Recently, OIG’s Office of Audit Services released its latest report on providers’ compliance with the Hospital Price Transparency Rule (the HPT Rule). The HPT Rule requires hospitals to make public (1) a machine-readable file containing a list of all standard charges for all items and services the hospital provides, and (2) a consumer-friendly list of standard charges for a limited set of shoppable services. OIG’s report titled, “Not All Selected Hospitals Complied With the Hospital Price Transparency Rule,” found—as the title suggests—that over a third of selected hospitals for the audit did not comply with the HPT Rule. The report extrapolates the sample results and estimates that forty-six percent of the 5,879 hospitals required to comply with the HPT Rule are out of compliance.
More on Report
Specifically, OIG found that 34 hospitals did not comply with one or more of the requirements associated with publishing comprehensive machine-readable files. Also, 14 hospitals did not comply with one or more of the requirements associated with displaying shoppable services in a consumer-friendly manner.” Based on the audit results, OIG estimates “that 46% of the 5879 hospitals that were required to comply with the HPT rule did not comply with the requirements to make information on their standard charges available to the public.”
During the audit process, OIG contacted each of the sampled hospitals and sought comment about each hospital’s experience with its efforts to implement and comply with the provisions of the HPT Rule. According to the report, many concerns generally addressed confusion or uncertainty that hospitals and their staffs had experienced in their understanding of the specific requirements. Some smaller hospitals (fewer than 100 beds) said that their own limited resources, as well as inadequate assistance from contractors, contributed to their difficulties in complying with the HPT Rule.
The report recommends that CMS take the following actions:
- Review noncompliant hospitals associated with OIG’s findings and, if CMS determines that the hospitals are noncompliant, execute CMS’s enforcement measures, to include issuing warning notices, corrective action plans, and/or civil monetary penalties as applicable;
- Use the information in the report and consider implementing changes suggested by hospitals, including providing written guidance clarifying the definition of “shoppable services” and developing a training and compliance program that is tailored for smaller hospitals; and
- Continue to strengthen its internal controls, to include allocating sufficient resources to maintain a robust program of reviews of the hospitals and their compliance with the HPT Rule.
CMS responded to each of the recommendations. First, CMS said that it had begun its own compliance review of the noncompliant hospitals identified during OIG’s audit. Second, CMS said that it had already published guidance related to its definition of “shoppable services.” CMS also stated that it would “conduct additional outreach to hospitals to educate them on [this] definition”. Third, CMS stated that the updated HPT Rule finalized in November 2023 strengthened its controls and review process.