65% of hospitals violate the federal price transparency rule, and the maximum fine is so low ($309,738) that large hospital systems treat it as a cost of doing business

Federal law has required hospitals to publish machine-readable files of their negotiated prices with every insurer since January 2021. As of June 2025, CMS had conducted over 5,149 compliance reviews and found that 65% of reviewed hospitals had received at least one warning notice or corrective action plan request. Only 21% of hospitals were fully compliant with all aspects of the rule. The OIG estimated that 46% of hospitals were not fully compliant based on its own audit sample. This matters because hospital price transparency was supposed to enable patients to comparison shop for medical services the way they compare prices for anything else. Without accurate, complete price data, a patient cannot know that Hospital A charges $4,500 for an MRI while Hospital B five miles away charges $800 for the same scan. The entire premise of the rule — that sunlight would create competitive pressure to lower prices — fails when the majority of hospitals either do not publish their data, publish incomplete data, or publish data in formats that are technically compliant but practically unusable. A GAO report found that CMS lacks the information to assess whether hospital pricing data is even complete or accurate. This problem persists because the enforcement mechanism is toothless. CMS fined only 3 hospitals in 2024 and 10 in 2025, with fines ranging from $32,301 to $309,738. For a hospital system generating hundreds of millions or billions in annual revenue, a $300,000 fine is a rounding error — far less than the revenue they would lose if patients could actually compare prices and choose lower-cost competitors. The rule requires hospitals to self-report their data with no independent verification, and the machine-readable file format requirements (changed in 2024 to require a CMS template) keep shifting, giving hospitals a perpetual excuse for non-compliance. The structural problem is that price transparency directly threatens hospital margins, and the penalty for non-compliance is orders of magnitude smaller than the financial benefit of opacity.