Hospital Enforcement Actions

Source: CMS Enforcement Actions - Hospitals

The Transparency in Coverage final rule requires hospitals to disclose the rates they privately negotiate with health plans, as well as their self-pay and charge master rates, and provide an online patient cost estimator tool or negotiated rate information for at least 300 “shoppable” services, or face penalties ranging from $300 to $5,500 per day, depending on the hospital’s size. CMS has issued a total of $3,915,632 in penalties.

Below are hospitals that have been notified of penalties (updated as of September 2024).

• Northside Hospital Atlanta. Effective date: September 2021. Penalty: $883,180
• Northside Hospital Cherokee. Effective date: September 2021. Penalty: $214,320
• Frisbie Memorial Hospital. Effective date: October 2022. Penalty: $102,660
• Kell West Regional Hospital. Effective date: July 2022. Penalty: $117,260
• Falls Community Hospital & Clinic. Effective date: January 2023. Penalty: $70,560
• Fulton County Hospital    *Under Review **. Effective date: December 2022. Penalty: $63,900
• Community First Medical Center. Effective date: June 2022. Penalty: $847,740
• Hospital General Castaner   *Under Review **. Effective date: September 2022. Penalty: $101,400
• Samaritan Hospital - Albany Memorial Campus   *Under Review **. Effective date: June 2023. Penalty: $56,940
• Doctors' Center Hospital Bayamón. Effective date: June 2023. Penalty: $102,200
• Betsy Johnson Hospital. Effective date: June 2023. Penalty: $99,540
• UF Health North. Effective date: February 2023. Penalty: RESOLVED
• Holy Cross Hospital *Under Review **. Effective date: June 2023. Penalty: $325,710
• West Covina Medical Center. Effective date: March 2023. Penalty: $59,100
• Jackson Memorial Hospital. Effective date: February 2024. Penalty: $871,122

Health Plan Enforcement Actions

Source: CMS Enforcement Actions - Health Plans

The Centers for Medicare & Medicaid Services (CMS) can impose civil money penalties on health plans that do not comply with transparency in coverage requirements. The penalties can be up to $100 per day for each violation and each person affected. The penalty is adjusted annually.

In general, CMS does not release information about ongoing investigations or compliance actions related to the Transparency in Coverage final rules.