type: timeline_event
The Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule took effect, requiring all 6,171 U.S. hospitals to provide clear, accessible pricing information in two formats: machine-readable files with all items and services, and consumer-friendly displays of 300 shoppable services. Despite the promise of transparency, compliance was abysmal and enforcement virtually nonexistent. A CMS assessment from early 2021 found only 27% of hospitals fully compliant. A study by Gondi et al. found that in a random sample of 100 of the highest-revenue hospitals, 83 were non-compliant with at least one major CMS requirement. Research found that 56% of hospitals providing shoppable services did not report any prices, 66% reported prices for only a portion of services they actually provide, and only 6% had complete concordance between price reporting and services offered. The initial penalty for non-compliance was a widely-criticized $300 per day (approximately $110,000 per year)—pocket change for large hospital systems with billions in revenue. In November 2021, CMS increased penalties to $5,500 per day ($2 million per year) for the largest hospitals (over 551 beds), but enforcement remained weak. From 2021-2023, CMS conducted compliance reviews of only 1,746 hospitals and initiated enforcement actions against 1,287 (74% of reviewed hospitals), but issued civil monetary penalties to only 14 hospitals totaling $4 million—while hospitals collectively earned over $1 trillion annually. Eighteen months after the rule took effect, CMS issued its first penalties to Northside Hospital Atlanta ($880,000) and Northside Hospital Cherokee ($214,000). A 2024 GAO report found CMS does not have assurance that pricing data are sufficiently complete and accurate, and has not assessed risks to determine if additional enforcement is needed. The failed implementation demonstrated that without meaningful penalties and vigorous enforcement, hospitals would simply ignore transparency mandates and continue price gouging with impunity.