Hospitals dodging imaging price transparency rule could face fines as high as $2M, CMS says

Hospitals dodging federal requirements to disclose prices for imaging and other “shoppable” healthcare services could face fines upward of $2 million under a new rule proposed Monday.

The Centers for Medicare & Medicaid Services began requiring institutions to provide upfront pricing for care, including 13 radiology services specified by the agency. However, recent analyses have discovered many hospitals failing to honor the new price transparency rule.

Members of Congress urged the administration to respond, prompting recent presidential action, along with Monday’s announcement.

“No medical entity should be able to throttle competition at the expense of patients,” Health and Human Services Secretary Xavier Becerra said July 19. “I have fought anti-competitive practices before, and strongly believe healthcare must be in reach for everyone. With today’s proposed rule, we are simply showing hospitals through stiffer penalties: concealing the costs of services and procedures will not be tolerated by this administration.”

CMS is proposing to increase the penalty for some institutions that fail to comply with the rule. Hospitals with a bed count of 30 or fewer would face civil monetary penalty of $300 per day (same as the original rule), while larger providers will pay $10 daily for each bed not to exceed $5,500. The cost for a full year of noncompliance would range from $109,500 per hospital, with a maximum of $2,007,500, the agency said in its announcement.

The administration is accepting suggestions for alternative methods of assessing penalties, including hospital revenue, the severity and scope of noncompliance, and the organizations reason for defiance. CMS will also prohibit hospitals from erecting barriers that make it harder to fine machine-readable files listing their prices, it said in a fact sheet.

Becerra and colleagues said they’ve unearthed widespread variation in prices, based on the info hospitals made public this year. One recent analysis found the price of a diagnostic ultrasound is seven times higher, depending on which state it’s delivered. Another study in JAMA discovered patients paying nearly five times as much for the same scan within the same institution, depending on their insurance.

“CMS is committed to ensuring consumers have the information they need to make fully informed decisions regarding their health care, since health care prices can cause significant financial burdens for consumers,” the agency said in its announcement.

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