Recently, the Centers for Medicare and Medicaid Services (CMS) issued a Hospital Price Transparency Notice of Imposition of a Civil Monetary Penalty (CMP) to Frisbie Memorial Hospital in Rochester, New York. The agency found that Frisbie Memorial Hospital was “noncompliant” with the Hospital Price Transparency rule since October 24, 2022. We have previously written about the Hospital Price Transparency rule and the seeming lack of compliance by hospitals throughout the country (see here and here).
In the Notice, CMS notes that it completed an initial review of the Frisbie Memorial Hospital website on July 23, 2021. On August 25, 2021, CMS issued a Warning Notice. On November 19, 2021, the CEO of Frisbie Memorial Hospital responded to the Warning Notice, providing additional information about its price estimator tool and its machine-readable file.
However, nearly a year later, on October 24, 2022, CMS once again reviewed the hospital’s website and machine-readable file, finding that the hospital was still noncompliant with the price transparency requirements. On October 24, 2022, CMS identified additional noncompliance findings and on November 2, 2022, CMS issued a Notice of Violation and Request for Corrective Action Plan (CAP) to Frisbie Memorial Hospital.
In the Notice of Violation and CAP, CMS stated that the hospital had seven violations related to its comprehensive machine-readable file, including failure to include all corresponding data elements in the list of standard charges. Some of the missing data elements included descriptions for each item and service, missing gross charges, missing payer specific negotiated rates, and missing some de-identified minimum and maximum negotiated rates. Additionally, CMS noted that the hospital did not list all discounted cash prices in the machine-readable file.
Frisbie Memorial Hospital had 45 days to submit its CAP to CMS but failed to do so. Not only did the hospital fail to submit a CAP in a timely manner, but neither the hospital nor its CEO contacted CMS in response to the Notice of Violation and CAP. CMS documents in the Notice multiple attempts made to contact Frisbie Memorial Hospital to “provide technical assistance about the hospital price transparency requirements and the request for a CAP,” leaving several detailed voicemails with administration.
CMS once again reviewed the Frisbie Memorial Hospital website on April 19, 2023, and it continued to be out of compliance in the same manner as previously. Therefore, the agency is imposing a $102,660 CMP (calculated as $10 per day per each of the hospital’s 58 beds for each of the 177 days of noncompliance), to be paid within 60 days.
CMS concluded the Notice by reminding Frisbie Memorial Hospital that “for hospitals that remain noncompliant, CMS may issue subsequent notices imposing additional CMPs for continuing violation(s)” and that CMS may also impose additional CMPs until CMS finds that the hospital is in full compliance with the Price Transparency Rule. As such, the agency recommends Frisbie Memorial Hospital get in compliance with the rule and reach back out to CMS immediately so that any future CMPs may be reduced.
Other CMPs Issued
This marks the third CMP issued by CMS for failure to comply with the Hospital Price Transparency rule. The first two were issued on June 7, 2022, to Northside Hospital Atlanta and Northside Hospital Cherokee. The fourth was issued the same day as the one issued to Frisbie Memorial Hospital, to Kell West Regional Hospital. Frisbie Memorial Hospital is the smallest CMP so far at $102,660.00, while Northside Hospital Atlanta is the largest at $883,180.00.
Kell West Regional Hospital
The Notice of Imposition of a CMP to Kell West Regional Hospital details myriad issues with the hospital’s lack of compliance, starting on July 8, 2022. On July 27, 2022, CMS issued a Warning Notice to the hospital, identifying material violations. When reviewing the website again on November 3, 2022, CMS found that the hospital was still in material violation of the rule and on November 7, 2022, issued a Request for CAP. Kell West Regional Hospital submitted a CAP on December 22, 2022, and submitted a revised CAP on January 19, 2023, which was approved by CMS. However, on March 31, 2023 – after the CAP completion date – CMS identified ongoing material violations of the rule. Therefore, CMS issued a $117,260.00 CMP to the hospital ($10 per 41 beds for 286 days of noncompliance).