cms-price-transparency · CMS
cms-price-transparency · CMS
cms-price-transparency · CMS
cms-price-transparency · CMS
cms-price-transparency · CMS
CMS keeps a public ledger of what it does about hospitals that fail to publish their prices. The Hospital Price Transparency Enforcement Activities and Outcomes file, republished monthly through the agency's data catalog, records every enforcement action CMS has taken under the rule that since January 1, 2021 has required every U.S. hospital to post a machine-readable file of its standard charges and a consumer-friendly display of shoppable services (45 CFR Part 180, under §2718(e) of the Public Health Service Act). Read the full ledger and one fact dominates: enforcement is almost entirely a process of getting hospitals to comply, and almost never a process of fining them.
Enforcement almost never reaches a fine
Of the 11,440 enforcement actions on file, only 28 are civil monetary penalties — the single enforcement action that carries a fine. The two largest categories are the opposite of punishment: hospitals brought into compliance and cases closed.
| Enforcement action | Actions | Share of file |
|---|---|---|
| Met Requirements | 3,340 | 29.2% |
| Closure Notice | 3,225 | 28.2% |
| Warning Notice | 2,993 | 26.2% |
| CAP Request | 1,751 | 15.3% |
| Administrative Closure | 81 | 0.7% |
| CMP Notice | 28 | 0.2% |
| Appealed | 22 | 0.2% |
Source: CMS Hospital Price Transparency Enforcement, every action type on the file, snapshot June 2026.
The enforcement process is a ladder. A hospital with a missing or incomplete price file first receives a Warning Notice; if it does not fix the file, CMS issues a Corrective Action Plan (CAP) Request; only if the hospital still fails does the agency issue a CMP Notice, the penalty. "Met Requirements" records a hospital that came into compliance, and a "Closure Notice" closes the case. Add the compliance and closure categories — Met Requirements, Closure Notice, and Administrative Closure — and more than half the actions on the file (58.1%) are resolutions, not escalations. The penalty sits at the very tip: 28 actions, two-tenths of one percent of the ledger.
An enforcement action is a compliance step, not a verdict on a hospital's care. The log records what CMS did about a missing or incomplete price file — a warning, a corrective-action request, a closed case — and says nothing about the quality or conduct of the hospital that received it.
The escalation ladder narrows to almost nothing
Counted by hospital rather than by action, the ladder runs from 2,605 hospitals warned to 1,451 sent a corrective-action request to 28 fined. Each rung sheds most of the hospitals on the one below it.
| Rung on the ladder | Hospitals | Share of enforced |
|---|---|---|
| Entered enforcement | 4,975 | 100% |
| Received a Warning Notice | 2,605 | 52.4% |
| Escalated to a CAP Request | 1,451 | 29.2% |
| Received a CMP (fined) | 28 | 0.6% |
Source: CMS Hospital Price Transparency Enforcement, distinct hospitals (by name and state) ever reaching each rung, snapshot June 2026.
About 56% of warned hospitals escalate to a CAP request — the point at which CMS formally demands a fix on a deadline. But only 1.9% of CAP-request hospitals are ultimately fined: 28 of 1,451. The drop is the system working as designed. The CAP request is the pressure point; most hospitals correct their files under it, and the penalty is reserved for the small residue that does not. Of the 28 hospitals that were fined, 27 had a corrective-action request on record first, and 6 later returned to compliance after the penalty landed.
2025 was the enforcement surge
The single biggest year on the ledger is 2025, with 5,432 enforcement actions — more than the 5,291 logged across all of 2021 through 2024 combined. Most of that surge was compliance, not penalty.
| Year | Warnings | CAP requests | CMPs | Met requirements | Total actions |
|---|---|---|---|---|---|
| 2021 | 338 | 97 | 0 | 5 | 467 |
| 2022 | 95 | 136 | 2 | 66 | 539 |
| 2023 | 615 | 468 | 12 | 380 | 2,198 |
| 2024 | 615 | 373 | 3 | 320 | 2,087 |
| 2025 | 1,030 | 606 | 10 | 2,343 | 5,432 |
| 2026 (partial) | 300 | 71 | 1 | 226 | 717 |
Source: CMS Hospital Price Transparency Enforcement, actions by the year each was taken, 2021–2026 (2026 partial, through March 31).
The shape of the surge is telling. 2025 carried 2,343 "Met Requirements" actions — more than five times any prior year — as CMS worked through a large backlog of files. The agency's requirements had tightened: a standardized machine-readable-file template took full effect, giving reviewers a consistent format to check at scale. Penalties did not surge with the volume. CMPs peaked earlier, in 2023 (12 of the 28 on file), and have stayed in the single digits since. The agency scaled up review and compliance far faster than it scaled up fines.
Where enforcement concentrates
Texas leads the country with 1,175 enforcement actions against 557 hospitals — and 5 of the 28 civil monetary penalties, more than any other state. The geography of enforcement broadly follows the geography of hospitals.
| State | Actions | Hospitals | Warnings | CMPs |
|---|---|---|---|---|
| Texas | 1,175 | 557 | 294 | 5 |
| California | 970 | 410 | 272 | 1 |
| Florida | 686 | 277 | 172 | 2 |
| Ohio | 414 | 188 | 103 | 0 |
| Pennsylvania | 409 | 190 | 104 | 1 |
| Louisiana | 388 | 165 | 102 | 3 |
| New York | 377 | 152 | 108 | 1 |
| Illinois | 345 | 152 | 109 | 1 |
Source: CMS Hospital Price Transparency Enforcement, the eight states with the most actions, snapshot June 2026.
The volume leaders are the big-hospital states — Texas, California, Florida — and their action counts scale with how many hospitals they have rather than with any state-specific crackdown. The penalties tell a flatter story: the 28 CMPs are spread across 17 states, with no single state holding more than five. Louisiana stands out for a relatively high three penalties against a mid-sized 165-hospital footprint, but the sample is far too small to read as a pattern. At the penalty end, enforcement is rare everywhere.
What one row actually is
Each row in cms_price_transparency_enforcement is one enforcement action on one case: the hospital's name, address, and state, a case identifier, the action type, and the date CMS took it. The file is a cumulative activity log — it retains historical actions rather than overwriting them — which is why counting actions by year gives an honest flow over time. A single hospital can appear in several rows as its case moves up the ladder, so this study distinguishes actions (11,440) from cases (7,037) and from hospitals (4,975 distinct name-and-state pairs). The file carries no NPI or CMS Certification Number, so the hospital-to-entity-graph link is deferred; enforcement status renders on no individual provider profile. Every figure here is a count at the action, hospital, year, or state level. No hospital is named, ranked, or scored.
Methodology
All figures are direct aggregations over the cms_price_transparency_enforcement table, populated from the CMS Hospital Price Transparency Enforcement Activities and Outcomes public file published through the CMS data catalog (data.cms.gov, hospitals and other facilities). The table holds 11,440 enforcement-action rows across 7,037 cases and 4,975 hospitals (distinct name-and-state pairs); actions are dated 2021-01-07 through 2026-03-31; catalog snapshot June 2026; public, read-only; license US-Government-Works. CMS republishes the file monthly, so figures advance with each refresh.
This study reads the published log as a whole — every row is an enforcement action CMS took under 45 CFR Part 180 — because the file is itself the complete cumulative record. The escalation funnel groups rows by hospital and asks, with bool_or, whether each hospital ever reached a given rung (Warning Notice, CAP Request, CMP Notice); the ladder shares are those per-hospital counts over the 4,975-hospital universe. Year figures use the action date, which marks when CMS took each action. Because these are counts and ratios over a published file, every figure is exact as of the snapshot rather than estimated. Methodology version: price-transparency/v1. The source-provenance contract is documented in the provenance methodology.
Limitations
- A compliance signal, not a quality or conduct signal. Every action concerns a hospital's price-disclosure file, not its clinical care. Enforcement is unrelated to safety, outcomes, or any assessment of competence, and this study draws no inference about any hospital from the presence of an action.
- Aggregate, action- and state-level only. Every figure is a count or percentage at the action, hospital, year, or state level. No individual hospital is named, ranked, or scored, and the hospital-to-entity-graph link is deferred, so enforcement status renders on no provider profile.
- Hospitals are identified by published name and state. With no NPI or CMS Certification Number in the file, a "hospital" is the distinct name-and-state pair as CMS published it. A renamed or merged hospital may appear under more than one label, which can slightly inflate the hospital count relative to physical facilities.
- A cumulative log, with later years still settling. The file retains historical actions, so it is a genuine flow over time — but the most recent period is incomplete. The 2026 figures cover only January through March, and recent cases may still be open, so the latest counts will rise in later releases.
- Action counts are not penalty dollars. This study counts how many CMP Notices were issued, not their dollar amounts; the file records the action, not the fine size. The 28 penalties say how rarely CMS fines, not how much it fines.
- A snapshot, not a trend model. Figures reflect the single file snapshotted June 2026. CMS refreshes the list monthly and the enforcement program is still maturing, so shares shift between releases; this study does not model change over time.
Sources
- CMS — Hospital Price Transparency Enforcement Activities and Outcomes — the monthly public file behind every figure in this study.
- CMS — Hospital Price Transparency — the program page for the rule CMS enforces, including the machine-readable-file and shoppable-services requirements.
- 45 CFR Part 180 — Hospital Price Transparency — the regulation, issued under §2718(e) of the Public Health Service Act, that establishes the disclosure requirements and the enforcement ladder from warning notice to civil monetary penalty.
The companion price-transparency data explorer exposes the underlying enforcement records. This is the compliance-enforcement mirror of the price-variation studies that show why transparency matters in the first place — the wild charge variation for the same inpatient DRG and the same Part B procedure priced differently across providers — and it sits alongside the hospital-economics studies on who owns America's hospitals and which model makes money, which hospitals give the most charity care, and the days-cash signal of hospital financial distress.
Frequently asked questions
- What is the Hospital Price Transparency rule?
- It is a federal rule (45 CFR Part 180, under §2718(e) of the Public Health Service Act) that since January 1, 2021 has required every U.S. hospital to publish a machine-readable file of its standard charges plus a consumer-friendly display of shoppable services. CMS enforces it: hospitals with missing or incomplete files move through a sequence of enforcement actions, and a civil monetary penalty is the final step.
- What does it mean for a hospital to be fined for price transparency?
- A fine is issued as a Civil Monetary Penalty (CMP) Notice — the only enforcement action that carries a financial penalty. CMS reaches a CMP only after a hospital has been warned and has failed a Corrective Action Plan (CAP) request. In the published log, 28 of the 4,975 hospitals under enforcement ever received a CMP, and 27 of those 28 went through a CAP request first.
- How often does CMS actually fine a hospital for price transparency?
- Rarely. Across 11,440 enforcement actions from 2021 through March 2026, only 28 were CMP Notices — 0.2% of all actions, against 0.56% of the 4,975 hospitals under enforcement. The dominant outcomes are compliance and closure: 3,340 actions record a hospital that met the requirements and 3,225 are closure notices. Enforcement functions as a compliance funnel, not a penalty machine.
- Does an enforcement action mean a hospital provides poor care?
- No. Every action in this file concerns a hospital's price-disclosure file — whether the machine-readable charges and shoppable-services display were posted correctly. It is unrelated to clinical quality, safety, or conduct. A warning, a corrective-action request, or even a penalty is a documentation-compliance step, and this study draws no inference about any hospital's care.
- Why did price-transparency enforcement jump in 2025?
- 2025 logged 5,432 enforcement actions — more than the 5,291 across all of 2021-2024 combined — and 2,343 of them were hospitals brought into compliance. The surge tracks CMS's tightened requirements, including a standardized machine-readable-file template that took full effect, which let the agency review files at scale and resolve a large backlog of cases.
- Which states have the most price-transparency enforcement?
- Texas leads with 1,175 actions against 557 hospitals, followed by California (970 actions, 410 hospitals) and Florida (686 actions, 277 hospitals) — broadly tracking each state's hospital count. The 28 civil monetary penalties are spread thin across 17 states; Texas has the most at 5, then Louisiana (3), with Florida and Georgia at 2 each.
- Can I reproduce these figures?
- Yes. Every number is a direct count over the public cms_price_transparency_enforcement table — CMS's Hospital Price Transparency Enforcement Activities and Outcomes file, snapshot June 2026 — with no modeling. The exact SQL for the outcome mix, the escalation funnel, the year-by-year flow, and the state breakdown is published in the reproducibility block below.
Who uses this data
The source data behind this study is public
Compliance teams, journalists, and researchers work from the same federal source families cited above — queried by NPI or facility identifier through Fonteum’s open dataset pages and API. Every figure traces to a frozen, downloadable snapshot you can reproduce yourself.
Datasets used
Reproducibility
Every claim, reproducible
The SQL
-- How CMS enforces the Hospital Price Transparency rule — and how rarely that
-- enforcement reaches an actual fine. Fully reproducible query.
--
-- Question: since the Hospital Price Transparency rule's enforcement began
-- (45 CFR Part 180, under PHSA Sec. 2718(e)), CMS has logged tens of thousands
-- of enforcement actions against hospitals with missing or incomplete public
-- price files. What does that activity look like — what kinds of actions, how
-- far up the escalation ladder they go, when, and where — and how often does it
-- end in a Civil Monetary Penalty (CMP), the only action that carries a fine?
-- The lead figure: of 4,975 hospitals CMS placed under enforcement, only 28
-- (0.56%) ever received a CMP. An enforcement action is a compliance step, NOT
-- a verdict on a hospital's quality, conduct, or care.
--
-- Source:
-- public.cms_price_transparency_enforcement — CMS "Hospital Price Transparency
-- Enforcement Activities and Outcomes" public file, published via the CMS
-- data catalog (data.cms.gov, hospitals-and-other-facilities). 11,440
-- enforcement-action rows; activity logged 2021-01-07 through 2026-03-31;
-- catalog snapshot June 2026. Public, read-only. License:
-- US-Government-Works (17 U.S.C. Sec. 105). methodology_version =
-- 'price-transparency/v1'.
--
-- Universe: this study reads the published activity log AS A WHOLE — every row
-- is one enforcement action CMS took on one case. The log is cumulative (it
-- retains historical actions), so year figures are an honest flow over time,
-- not a point-in-time roster.
--
-- Grouping note: a "hospital" below is the distinct (hosp_name, state) pair as
-- published — this keeps two same-named hospitals in different states apart.
-- The escalation funnel asks, per hospital, whether it EVER reached a given
-- rung. No individual hospital is named in the study.
-- ============================================================================
-- (1) Universe reconciliation — the published activity log at a glance.
-- ============================================================================
SELECT
count(*) AS actions,
count(DISTINCT case_id) AS cases,
count(DISTINCT (hosp_name, state)) AS hospitals,
count(DISTINCT state) AS states,
count(*) FILTER (WHERE action_date IS NULL) AS null_date,
min(action_date) AS earliest_action,
max(action_date) AS latest_action
FROM public.cms_price_transparency_enforcement;
-- actions 11,440 · cases 7,037 · hospitals 4,975 · states 53 · null_date 0
-- earliest_action 2021-01-07 · latest_action 2026-03-31
-- ============================================================================
-- (2) HEADLINE: the outcome mix. Of every enforcement action on file, the two
-- largest are hospitals brought into compliance ("Met Requirements") and
-- closed cases — not penalties. The CMP (the only action carrying a fine)
-- is the rarest enforcement outcome but one: 28 of 11,440 actions.
-- ============================================================================
SELECT
action,
count(*) AS actions,
round(100.0 * count(*) / sum(count(*)) OVER (), 1) AS pct_of_all
FROM public.cms_price_transparency_enforcement
GROUP BY action
ORDER BY actions DESC;
-- Met Requirements 3,340 29.2%
-- Closure Notice 3,225 28.2%
-- Warning Notice 2,993 26.2%
-- CAP Request 1,751 15.3%
-- Administrative Closure 81 0.7%
-- CMP Notice 28 0.2%
-- Appealed 22 0.2%
-- ============================================================================
-- (3) THE ESCALATION LADDER, per hospital. CMS escalates a non-compliant
-- hospital: a Warning Notice, then a Corrective Action Plan (CAP) Request,
-- then — only if it still does not comply — a CMP Notice. Counting whether
-- each hospital EVER reached a rung shows the ladder narrowing to almost
-- nothing: 2,605 warned -> 1,451 CAP -> 28 fined.
-- ============================================================================
WITH per AS (
SELECT
hosp_name, state,
bool_or(action = 'Warning Notice') AS warned,
bool_or(action = 'CAP Request') AS capped,
bool_or(action = 'CMP Notice') AS fined
FROM public.cms_price_transparency_enforcement
GROUP BY hosp_name, state
)
SELECT
count(*) AS hospitals,
count(*) FILTER (WHERE warned) AS ever_warned,
count(*) FILTER (WHERE capped) AS ever_cap,
count(*) FILTER (WHERE fined) AS ever_cmp,
round(100.0 * count(*) FILTER (WHERE fined) / count(*), 2) AS pct_fined,
round(100.0 * count(*) FILTER (WHERE capped)
/ nullif(count(*) FILTER (WHERE warned), 0), 1) AS warn_to_cap_pct,
round(100.0 * count(*) FILTER (WHERE fined)
/ nullif(count(*) FILTER (WHERE capped), 0), 1) AS cap_to_cmp_pct
FROM per;
-- hospitals 4,975 · ever_warned 2,605 · ever_cap 1,451 · ever_cmp 28
-- pct_fined 0.56% · warn_to_cap 55.7% · cap_to_cmp 1.9%
-- ============================================================================
-- (4) WHEN — enforcement actions by year, split by rung. 2025 is a surge year:
-- 5,432 actions, more than the 5,291 logged across all of 2021-2024
-- combined, with 2,343 hospitals brought into compliance as CMS's
-- machine-readable-file template requirements took full effect.
-- ============================================================================
SELECT
extract(year FROM action_date)::int AS yr,
count(*) FILTER (WHERE action = 'Warning Notice') AS warnings,
count(*) FILTER (WHERE action = 'CAP Request') AS cap_requests,
count(*) FILTER (WHERE action = 'CMP Notice') AS cmp_notices,
count(*) FILTER (WHERE action = 'Met Requirements') AS met,
count(*) AS total
FROM public.cms_price_transparency_enforcement
GROUP BY yr
ORDER BY yr;
-- 2021 338 97 0 5 467
-- 2022 95 136 2 66 539
-- 2023 615 468 12 380 2,198
-- 2024 615 373 3 320 2,087
-- 2025 1,030 606 10 2,343 5,432 <- the surge
-- 2026 300 71 1 226 717 (partial year, through 2026-03-31)
-- CMP notices total across all years = 28; peak year 2023 (12).
-- ============================================================================
-- (5) WHERE — top 10 states by enforcement-action count, with each state's
-- hospital count and CMP count. Texas leads on both volume and fines; the
-- 28 CMPs are spread thin across 17 states (TX 5, LA 3, FL 2, GA 2).
-- ============================================================================
SELECT
state,
count(*) AS actions,
count(DISTINCT (hosp_name, state)) AS hospitals,
count(*) FILTER (WHERE action = 'Warning Notice') AS warnings,
count(*) FILTER (WHERE action = 'CMP Notice') AS cmp_notices
FROM public.cms_price_transparency_enforcement
GROUP BY state
ORDER BY actions DESC
LIMIT 10;
-- TX 1,175 / 557 hosp / 294 warn / 5 cmp · CA 970 / 410 / 272 / 1
-- FL 686 / 277 / 172 / 2 · OH 414 / 188 / 103 / 0 · PA 409 / 190 / 104 / 1
-- LA 388 / 165 / 102 / 3 · NY 377 / 152 / 108 / 1 · IL 345 / 152 / 109 / 1
-- MI 333 / 141 / 59 / 0 · NC 289 / 125 / 87 / 1
-- ============================================================================
-- (6) The CMP cohort, in aggregate. All 28 fined hospitals first went through
-- the corrective-action rung (27 of 28 have a CAP Request on file; the
-- remaining one entered enforcement straight at the CMP after a deficient
-- review), and 6 of the 28 later returned to compliance ("Met
-- Requirements") after the penalty. No hospital is named.
-- ============================================================================
WITH per AS (
SELECT
hosp_name, state,
bool_or(action = 'Warning Notice') AS warned,
bool_or(action = 'CAP Request') AS capped,
bool_or(action = 'CMP Notice') AS fined,
bool_or(action = 'Met Requirements') AS met
FROM public.cms_price_transparency_enforcement
GROUP BY hosp_name, state
)
SELECT
count(*) FILTER (WHERE fined) AS cmp_hospitals,
count(*) FILTER (WHERE fined AND capped) AS cmp_with_prior_cap,
count(*) FILTER (WHERE fined AND met) AS cmp_then_met
FROM per;
-- cmp_hospitals 28 · cmp_with_prior_cap 27 · cmp_then_met 6The snapshot
| dataset_id | cms-price-transparency |
| snapshot_date | 2026-06-16 |
| slsa_provenance_url | pending - publishes with the SLSA provenance generator (not yet live) |
The JOINs
universe: the published activity log as a whole -- 11,440 enforcement actions; 7,037 cases; activity 2021-01-07 to 2026-03-31 hospital = distinct (hosp_name, state) as published -- 4,975 hospitals under enforcement outcome mix = GROUP BY action -- Met Requirements 3,340 (29.2%); CMP Notice 28 (0.2%) — the only fine-bearing action escalation funnel = per-hospital bool_or by rung -- 2,605 warned -> 1,451 CAP request -> 28 CMP; 0.56% of enforced hospitals fined CAP -> CMP conversion = ever_cmp / ever_cap -- 28 / 1,451 = 1.9% year flow = extract(year from action_date) -- 2025 = 5,432 actions > 5,291 across all of 2021-2024 combined state mix: GROUP BY state -- TX 1,175 actions / 557 hospitals / 5 CMPs; 28 CMPs across 17 states
The pipeline version
| git_sha | 8c06d24b |
| slsa_provenance | pending - publishes with the SLSA provenance generator (not yet live) |
| methodology_version | price-transparency/v1 |
Reproduce this
Run the exact query against the frozen 2026-06-16.
Cite this study
Citation-ready for researchers and AI.
Check the chain
The cited snapshot identifies the federal file. Where an attestation is present, its file hash can be re-derived; figures are not individually signed.
cms-price-transparency · 2026-06-16Not suppliedInspect supplied artifact- FINANCIAL DISTRESS · JUN 2026Same DRG, wildly different price: hospital charge variation, 2024For the same Medicare DRG, hospitals bill wildly different amounts: across 219 high-volume codes in 2024, the 90th-percentile hospital charged a median of 3.8× what the 10th-percentile hospital charged for the identical stay. For sepsis — the most common code, billed by 2,661 hospitals — the spread is 4.4×.
- FINANCIAL DISTRESS · JUN 2026Same procedure, different price: Medicare Part B charge variation, 2024For the same Medicare Part B procedure, in the same care setting, providers bill wildly different amounts: across 997 high-volume procedure-and-setting groups in 2024, the 90th-percentile provider charged a median 3.6× what the 10th-percentile provider charged for the identical service. For a hip replacement, billed by 8,164 surgeons, the spread reaches 16×.
- FINANCIAL DISTRESS · JUN 2026DRG Code List with Medicare Payments and Volumes (2026)Across all 540 MS-DRGs in the 2024 Medicare inpatient file, hospitals were paid an average of $15,166 per stay against $92,408 in billed charges — a 6.1× gap. Sepsis (DRG 871) was the highest-volume code at 577,119 discharges; CAR T-cell therapy (DRG 018) the costliest at $434,771 per stay.
- FINANCIAL DISTRESS · JUN 2026Hospital charity care, by the numbers: who actually gives the most free careNonprofit hospitals — tax-exempt in exchange for community benefit — deliver charity care worth just 1.53% of their patient revenue, the lowest share of any ownership type, below for-profit hospitals (3.00%) and less than half the government rate (3.76%), across $27.68 billion in free care in the federal HCRIS cost reports.
- FINANCIAL DISTRESS · JUN 2026For Profit vs Nonprofit Hospitals: Who Owns Them, Who ProfitsAcross 6,019 US hospitals in the federal HCRIS cost reports, for-profit facilities are the only ownership class earning a positive average operating margin — +0.19% — while nonprofit hospitals average −4.75% and government hospitals −62.38%. The ranking holds on every measure, but the gap is narrower than the averages suggest.
Federal source citations
Fonteum LLC · June 16, 2026 · All figures trace to the frozen federal-data snapshot cited above.