{
  "study": {
    "slug": "hospital-price-transparency-compliance-2026",
    "title": "Hospital Price Transparency Enforcement: 11440 CMS Actions Since 2021",
    "url": "https://fonteum.com/research/hospital-price-transparency-compliance-2026",
    "methodology_version": "price-transparency/v1"
  },
  "data_as_of": "2026-03-31",
  "temporal_coverage": "2021-01-01/2026-03-31",
  "sources": [
    {
      "name": "CMS Hospital Price Transparency Enforcement Activities and Outcomes",
      "publisher": "U.S. Centers for Medicare & Medicaid Services",
      "url": "https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-price-transparency-enforcement-activities-and-outcomes",
      "release_date": "2026-03-31",
      "retrieved_at": "2026-03-31",
      "license": "U.S. Government Works (17 U.S.C. §105)"
    }
  ],
  "headline": {
    "published": "2026-06-06",
    "total_enforcement_actions": 11440,
    "unique_review_cases": 4988,
    "civil_monetary_penalty_notices": 28,
    "warning_notices": 2993,
    "corrective_action_plan_requests": 1751,
    "met_requirements_determinations": 3340,
    "closure_notices": 3225,
    "administrative_closures": 81,
    "appealed": 22,
    "peak_year": 2025,
    "peak_year_actions": 5432
  },
  "sections": [
    {
      "id": "by_year",
      "label": "Enforcement actions by year",
      "columns": [
        "year",
        "actions"
      ],
      "rows": [
        {
          "year": 2021,
          "actions": 186
        },
        {
          "year": 2022,
          "actions": 893
        },
        {
          "year": 2023,
          "actions": 2130
        },
        {
          "year": 2024,
          "actions": 2799
        },
        {
          "year": 2025,
          "actions": 5432
        }
      ]
    },
    {
      "id": "by_state",
      "label": "Top 20 states by total enforcement actions",
      "columns": [
        "state",
        "total_actions",
        "warning_notices",
        "corrective_action_plan_requests",
        "civil_monetary_penalty_notices",
        "met_requirements"
      ],
      "rows": [
        {
          "state": "TX",
          "total_actions": 1175,
          "warning_notices": 294,
          "corrective_action_plan_requests": 152,
          "civil_monetary_penalty_notices": 5,
          "met_requirements": 399
        },
        {
          "state": "CA",
          "total_actions": 970,
          "warning_notices": 272,
          "corrective_action_plan_requests": 135,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 277
        },
        {
          "state": "FL",
          "total_actions": 686,
          "warning_notices": 172,
          "corrective_action_plan_requests": 82,
          "civil_monetary_penalty_notices": 2,
          "met_requirements": 223
        },
        {
          "state": "OH",
          "total_actions": 414,
          "warning_notices": 103,
          "corrective_action_plan_requests": 72,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 108
        },
        {
          "state": "PA",
          "total_actions": 409,
          "warning_notices": 104,
          "corrective_action_plan_requests": 65,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 116
        },
        {
          "state": "LA",
          "total_actions": 388,
          "warning_notices": 102,
          "corrective_action_plan_requests": 99,
          "civil_monetary_penalty_notices": 3,
          "met_requirements": 57
        },
        {
          "state": "NY",
          "total_actions": 377,
          "warning_notices": 108,
          "corrective_action_plan_requests": 66,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 93
        },
        {
          "state": "IL",
          "total_actions": 345,
          "warning_notices": 109,
          "corrective_action_plan_requests": 48,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 81
        },
        {
          "state": "MI",
          "total_actions": 333,
          "warning_notices": 59,
          "corrective_action_plan_requests": 43,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 156
        },
        {
          "state": "NC",
          "total_actions": 289,
          "warning_notices": 87,
          "corrective_action_plan_requests": 32,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 81
        },
        {
          "state": "GA",
          "total_actions": 283,
          "warning_notices": 75,
          "corrective_action_plan_requests": 47,
          "civil_monetary_penalty_notices": 2,
          "met_requirements": 82
        },
        {
          "state": "IN",
          "total_actions": 282,
          "warning_notices": 73,
          "corrective_action_plan_requests": 49,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 76
        },
        {
          "state": "KS",
          "total_actions": 265,
          "warning_notices": 71,
          "corrective_action_plan_requests": 40,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 76
        },
        {
          "state": "TN",
          "total_actions": 254,
          "warning_notices": 55,
          "corrective_action_plan_requests": 31,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 102
        },
        {
          "state": "AZ",
          "total_actions": 249,
          "warning_notices": 61,
          "corrective_action_plan_requests": 38,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 74
        },
        {
          "state": "NJ",
          "total_actions": 245,
          "warning_notices": 55,
          "corrective_action_plan_requests": 56,
          "civil_monetary_penalty_notices": 1,
          "met_requirements": 54
        },
        {
          "state": "MO",
          "total_actions": 240,
          "warning_notices": 58,
          "corrective_action_plan_requests": 39,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 71
        },
        {
          "state": "AL",
          "total_actions": 239,
          "warning_notices": 52,
          "corrective_action_plan_requests": 62,
          "civil_monetary_penalty_notices": 2,
          "met_requirements": 53
        },
        {
          "state": "IA",
          "total_actions": 238,
          "warning_notices": 66,
          "corrective_action_plan_requests": 20,
          "civil_monetary_penalty_notices": 0,
          "met_requirements": 86
        },
        {
          "state": "AR",
          "total_actions": 221,
          "warning_notices": 65,
          "corrective_action_plan_requests": 41,
          "civil_monetary_penalty_notices": 2,
          "met_requirements": 43
        }
      ]
    }
  ],
  "limitations": [
    "Snapshot-based: enforcement actions added after the monthly snapshot do not appear until the next pull.",
    "Hospital identity in the CMS export is name + address string — no NPI or CCN, limiting automated cross-referencing to provider registries.",
    "CMP dollar amounts are not published in this dataset; the CMS record reports only the existence of a CMP Notice. When a separately identified snapshot has attestation metadata, it covers that snapshot object and does not sign the CMP-notice fact.",
    "A hospital may appear with multiple Case_IDs across separate review cycles; the dataset records enforcement actions, not current compliance status.",
    "Federal enforcement only; state-level price transparency enforcement actions are outside the scope of this dataset.",
    "The 'Appealed' action type does not indicate outcome — the dataset does not record appeal results."
  ],
  "reproducible_sql": null,
  "license": "U.S. Government Works (17 U.S.C. §105)",
  "generated_by": "Fonteum — https://fonteum.com",
  "notes": "Aggregate, source-traced figures frozen to the as-of date above. Re-derive by running the published query against the named source file; no per-person records are included."
}