Hospital Price Transparency: Why 37% of Hospitals Still Aren't Complying and What It Means for Patients

A shocking new government audit reveals that 37% of hospitals are still not complying with federal price transparency requirements, more than four years after the rules took effect. With President Trump's February 2025 executive order promising aggressive enforcement and higher penalties, the healthcare pricing landscape is about to change dramatically—but patients still face major challenges accessing clear cost information.

The Compliance Crisis

A recent Department of Health and Human Services audit examined 100 randomly selected hospitals and found alarming non-compliance rates. Of the hospitals reviewed:

• 37 hospitals failed to meet one or both key requirements

• 34 hospitals didn't comply with machine-readable file requirements

• Standard charge information was missing or incomplete across multiple facilities

This widespread non-compliance persists despite federal rules requiring hospitals to publish their prices online since January 1, 2021. The audit findings prompted recommendations for stronger CMS enforcement and increased penalties for non-compliant facilities.

What Hospitals Must Disclose (But Often Don't)

Current federal regulations require hospitals to make pricing information public in two specific ways:

Machine-Readable Files (MRF)

• Complete price lists in a standardized digital format

• Payer-specific negotiated rates for all services

• Cash discount prices for uninsured patients

• Gross charges before any discounts or negotiations

Consumer-Friendly Price Lists

• 300 "shoppable services" in easy-to-understand format

• Estimated out-of-pocket costs based on insurance type

• Service bundling information for common procedures

• Clear pricing comparisons across different service options

Starting January 1, 2025, hospitals also must include "estimated allowed amounts" - the average dollar amount historically received from insurers for each service.

Trump's 2025 Enforcement Crackdown

President Trump's February 25, 2025 executive order titled "Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information" signals a major shift in enforcement strategy. The order directs federal agencies to:

• "Take all necessary and appropriate action" to ensure compliance within 90 days

• Ramp up enforcement with more aggressive audits and higher penalties

• Standardize pricing data across hospitals for easier comparison shopping

• Expand transparency requirements potentially to other healthcare stakeholders

CMS immediately responded by announcing plans for a "more systematic monitoring and enforcement approach," suggesting significant changes ahead for non-compliant hospitals.

Current Penalties vs. Future Enforcement

Under existing rules, hospitals face civil monetary penalties ranging from $300 to $5,500 per day depending on hospital size. To date, CMS has fined only 18 hospitals for non-compliance—a remarkably low number given widespread violations.

The enhanced enforcement could introduce:

Administrative Penalties

• Escalating fines for repeated violations

• More aggressive auditing of hospital pricing data

• Public disclosure of non-compliant facilities

Civil Enforcement Actions

• Department of Justice litigation against major health systems

• State attorney general civil lawsuits

• Injunctive relief requiring immediate compliance

Expanded Scope

• Health plan transparency requirements potentially included

• Pharmaceutical pricing disclosures under consideration

• Broader stakeholder compliance obligations

Why Hospitals Resist Transparency

Several factors contribute to hospital non-compliance:

Competitive Concerns

• Fear of price competition from other hospitals

• Negotiated rate secrecy historically protected profit margins

• Market positioning challenges when prices are public

Technical Complexity

• Data management difficulties across complex health systems

• Multiple payer contracts with varying rate structures

• System integration challenges for smaller hospitals

Resource Constraints

• Staff training requirements for compliance

• Technology investments needed for proper disclosure

• Ongoing maintenance of pricing databases

What This Means for Patients

Despite transparency rules, patients still face significant challenges:

Limited Awareness

• Fewer than 20% of patients discuss costs with physicians before treatment

• Most patients unaware of existing price transparency tools and requirements

• Complex medical terminology makes price comparisons difficult

Incomplete Information

• Actual costs vary significantly from posted prices

• Insurance-specific rates often unclear or missing

• Bundled services make total cost estimation challenging

Access Barriers

• Machine-readable files require technical expertise to use

• Consumer-friendly lists limited to 300 services

• Emergency situations don't allow price shopping

How to Access Hospital Pricing Information

Until enforcement improves compliance, patients can still seek pricing information:

Before Non-Emergency Care

• Request written estimates for planned procedures

• Ask for "good faith estimates" if you're uninsured

• Compare prices across different hospitals when possible

• Verify insurance coverage and network status

Using Available Tools

• Check hospital websites for posted price lists

• Use healthcare price comparison apps and websites

• Contact hospital billing departments directly for estimates

• Review insurance plan cost-sharing requirements

Know Your Rights

• Good faith estimates required for uninsured patients

• Dispute processes available if final bills significantly exceed estimates

• Insurance appeals for coverage denials

• State consumer protection resources for billing problems

The Road Ahead

With only 21.1% of hospitals in full compliance according to recent studies, the 2025 enforcement push represents a critical moment for healthcare price transparency. Patients may soon have better access to meaningful pricing information, but success depends on:

• Robust federal enforcement following through on executive order mandates

• Standardized data formats making price comparisons easier

• Consumer education helping patients navigate available information

• Technology improvements simplifying price transparency tools

The combination of widespread non-compliance, aggressive enforcement promises, and growing consumer demand for pricing information suggests 2025 will be a pivotal year for healthcare price transparency. Patients should stay informed about their rights while advocating for clear, accurate pricing information from their healthcare providers.

While true price transparency remains elusive, increased enforcement pressure may finally deliver the meaningful cost information that American patients deserve—and desperately need—to make informed healthcare decisions.