As of 2026, the federal government has fined 27 hospitals for violating the Hospital Price Transparency Rule, with penalties totaling well over $5 million since enforcement began in June 2022. The Centers for Medicare and Medicaid Services (CMS) accelerated its enforcement in 2025, issuing 10 fines in a single year, more than any previous year, and overhauled the rules again in 2026 to close loopholes hospitals had been exploiting for years.
Quick Answer: CMS has fined 27 hospitals for price transparency violations since 2022, with 2025 seeing the most enforcement activity (10 fines). The largest single fine was $979,000 (UF Health North, Jacksonville FL). As of April 2026, new rules require hospitals to publish actual claims-based pricing data instead of placeholder estimates, and a senior executive must attest in writing that the data is accurate.
For patients, this matters beyond the headlines. Hospital price data is now more accurate than ever, and tools like the CoveredUSA Bill Analyzer use this data to flag whether what your hospital billed you matches what they're legally required to disclose.
Why Hospitals Are Required to Post Prices
The Hospital Price Transparency Rule took effect January 1, 2021, requiring every U.S. hospital to publish two sets of pricing data:
- A machine-readable file (MRF): a comprehensive data file listing standard charges for all items and services
- A consumer-friendly shoppable services list: 300 common services displayed in plain language
The rule was enacted under the 2019 Executive Order on Improving Price and Quality Transparency in American Healthcare. Congress later reinforced it through the Consolidated Appropriations Act of 2021.
The goal is straightforward: before hospitals could hide prices behind contracts, making it nearly impossible for patients to comparison-shop or verify their bills. The rule aims to end that.
According to CMS.gov, hospitals must post:
- Gross charges
- Discounted cash prices
- Payer-specific negotiated charges
- De-identified minimum and maximum negotiated charges
Failure to comply triggers a correction action plan (CAP) and, if the hospital still doesn't fix the problem, a civil monetary penalty (CMP).
How CMS Calculates the Fine Amount
Fine amounts are based on hospital bed count and the number of days a hospital was noncompliant. As of 2026, the penalty structure is:
| Hospital Size | Maximum Daily Fine |
|---|
| 30 beds or fewer | $300 per day |
| 31 to 550 beds | $10 per bed per day |
| More than 550 beds | $5,500 per day |
A 500-bed hospital noncompliant for 60 days could face a fine of $30,000 ($10 x 500 beds x 60 days). A large academic medical center with 600 beds would hit the $5,500 daily cap, or $330,000 over 60 days.
Beginning January 1, 2026, hospitals can receive a 35% reduction in their penalty by waiving the right to a formal hearing within 30 calendar days of receiving the fine notice. CMS can withhold this option if the hospital failed to post either the machine-readable file or the shoppable services list entirely.
Complete List of All Hospitals Fined (2022 to Present)
CMS began issuing fines in June 2022. Through early 2026, 27 hospitals have received civil monetary penalties. Here is the full list organized by year.
2022 Fines (First Enforcement Year)
CMS issued the first-ever price transparency fines in June 2022 to two hospitals in the Northside Health System in Georgia. Both failed to post machine-readable files and consumer-friendly price lists.
| Hospital | State | Fine Amount | Beds |
|---|
| Northside Hospital Atlanta | GA | $883,180 | 536 |
| Northside Hospital Cherokee | GA | $214,320 | smaller system hospital |
2023 Fines
Two more hospitals received CMPs in 2023. Frisbie Memorial Hospital in New Hampshire was first deemed noncompliant by CMS on July 23, 2021, but the CMP issued April 19, 2023 only counted violations starting October 24, 2022.
| Hospital | State | Fine Amount |
|---|
| Frisbie Memorial Hospital | NH | $102,660 |
| Kell West Regional Hospital | TX | $117,260 |
2024 Fines
Enforcement picked up in 2024. The largest fine in CMS history was issued to Jackson Memorial Hospital in Miami, the flagship of the Jackson Health System and one of the largest public hospital systems in the country. Three additional hospitals received CMPs.
| Hospital | State | Fine Amount |
|---|
| UF Health North | FL | $979,000 |
| Jackson Memorial Hospital | FL | $871,122 |
| Community First Medical Center | IL | $847,740 |
| Holy Cross Hospital | MD | $325,710 |
| Doctors' Center Hospital Bayamon | Puerto Rico | $102,200 |
| Hospital General Castaner | Puerto Rico | $101,400 |
| Betsy Johnson Hospital | NC | $99,540 |
| Falls Community Hospital and Clinic | TX | $70,560 |
| Fulton County Hospital | AR | $63,900 |
| West Covina Medical Center | CA | $59,100 |
| Samaritan Hospital Albany Memorial Campus | NY | $56,940 |
Note: Some of the 2024 fines listed above may reflect CMP notices issued in late 2023 or early 2024. The official timeline per CMS records can be found at cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions.
2025 Fines (10 Hospitals, Most Active Year to Date)
CMS issued 10 fines in 2025, more than double the pace of prior years. Four of the 10 hospitals had 30 or fewer beds, demonstrating that CMS targets small hospitals as readily as large ones. Five of the 10 had active appeals as of mid-2025.
| Hospital | State | Fine Amount | Appeal Status |
|---|
| Arkansas Methodist Medical Center | AR | $309,738 | Under review |
| Northlake Behavioral Health System | LA | $257,180 | Under review |
| Lawrence Rehabilitation Hospital | NJ | $120,120 | None noted |
| Community Care Hospital | LA | $93,214 | Under review |
| Hill Hospital of Sumter County | AL | $84,216 | None noted |
| Bucktail Medical Center | PA | $75,582 | Under review |
| D.W. McMillan Memorial Hospital | AL | $71,852 | None noted |
| First Surgical Hospital | TX | $62,016 | Under review |
| CCM Health Hospital and Clinic | MN | $55,611 | None noted |
| Southeast Regional Medical Center | LA | $32,301 | None noted |
The $32,301 fine on Southeast Regional Medical Center (Kentwood, LA) is the smallest CMS has ever issued. The $309,738 fine on Arkansas Methodist Medical Center is the sixth-highest to date.
Cumulative Enforcement Totals (as of 2026)
| Metric | Count |
|---|
| Total hospitals fined | 27 |
| Total warning notices issued | 2,291+ |
| Total correction action plan requests | 1,331+ |
| Fines with active appeals | 11 |
| Enforcement years active | 4 (2022-2025) |
What Changed in 2026: Tighter Rules, No More Placeholders
For years, hospitals exploited a loophole in the price transparency rules. Instead of posting real prices negotiated with insurers, they submitted placeholder numbers. One analysis found that more than 90% of "estimated allowed amounts" in large hospital machine-readable files used the placeholder value "999999999."
CMS closed that loophole in November 2025 through the CY 2026 Outpatient Prospective Payment System final rule. New requirements effective January 1, 2026, with enforcement beginning April 1, 2026:
-
Actual claims data required. Hospitals must now calculate allowed amounts using 12 to 15 months of real claims history, sourced from Electronic Data Interchange (EDI) 835 electronic remittance advice files.
-
Three new data points required. Instead of a single estimated amount, hospitals must publish the median allowed amount, the 10th percentile allowed amount, and the 90th percentile allowed amount for each item or service.
-
Executive attestation. A hospital CEO or designated senior official must attest in writing that the posted prices are "true, accurate, and complete." This creates individual accountability for noncompliance.
-
New organizational NPI requirement. Hospitals must encode their Type 2 (organizational) National Provider Identifier in machine-readable files.
Per CMS's November 2025 fact sheet, the changes are intended to ensure patients have information they need to make well-informed healthcare decisions by requiring disclosure of actual prices.
Why Enforcement Has Been Slow Relative to the Violation Rate
CMS issued 2,291 warning notices and 1,331 correction action plan requests through early 2026, but only 27 civil monetary penalties. That's a conversion rate of roughly 1.2% from warning to fine.
Critics have noted this gap. A 2025 Health Affairs Forefront analysis argued that the enforcement mechanism rewards delay: hospitals can ignore warnings for months, submit a correction plan, drag out the review, and often never pay a penalty. The large fines issued to UF Health North ($979,000) and Jackson Memorial ($871,122) are exceptions, not the norm.
The 2026 executive attestation requirement is designed to change the incentive structure. When a named executive is personally on record certifying the data is accurate, the cost of noncompliance becomes more than just a fine. It becomes a compliance and career risk.
What This Means If You Have a Hospital Bill
Price transparency data is primarily used by employers, health plan administrators, and researchers. But patients with large medical bills can use it too.
If your hospital has published a compliant machine-readable file, you can look up what your insurer's negotiated rate is for the procedure you received. If your Explanation of Benefits (EOB) shows you were billed at the gross charge rate, or if the billed amount looks out of line with the negotiated rate your insurer should have, that is worth disputing.
The CoveredUSA Bill Analyzer compares each line on your hospital bill to the Medicare rate and publicly available pricing benchmarks to identify potential overcharges, billing errors, and charity care programs you may not know about. Upload your hospital bill to the free CoveredUSA Bill Analyzer to find errors, overcharges, and charity care options in 30 seconds.
How Hospitals Can Avoid Fines: The Compliance Process
For hospital administrators and compliance officers reading this, the CMS enforcement process follows a specific sequence:
Steps in the CMS Enforcement Process
- CMS reviews your hospital's public pricing data. CMS contractors conduct compliance reviews of all hospitals' posted prices.
- Warning letter issued. If violations are found, CMS sends a written warning with a description of the deficiencies.
- Correction action plan (CAP) required. If the hospital doesn't correct the issues voluntarily, CMS requests a CAP outlining specific remediation steps.
- CMP notice issued. If the CAP is not submitted or not followed, CMS issues a civil monetary penalty notice.
- 30-day waiver window. As of 2026, hospitals can reduce their fine by 35% by waiving their right to a hearing within 30 calendar days.
- Hearing or payment. If the hospital doesn't waive, they can request a formal hearing before an administrative law judge.
Documents Needed for Compliance Review
If your hospital receives a warning or CAP request from CMS, you will typically need:
- Current machine-readable file (MRF) URL confirmed publicly accessible
- Documentation that the MRF meets the new 2026 format requirements (median, 10th, 90th percentile data from EDI 835 source)
- Consumer-friendly shoppable services list accessible on hospital website footer
- Executive attestation signed by CEO or designated senior official
- Affirmation of organizational NPI encoded in MRF
Common Reasons Hospitals Get Fined
- MRF not publicly accessible (broken link, authentication required)
- No footer link to the MRF from the hospital homepage
- Placeholder values ("999999999") used instead of actual claims-based data
- Shoppable services list missing or not displaying all 300 required services
- MRF format does not conform to CMS schema requirements
- Failure to include payer-specific negotiated charges
The official resources for hospital compliance are available at cms.gov/priorities/key-initiatives/hospital-price-transparency.
Frequently Asked Questions
How many hospitals have been fined for price transparency violations?
As of early 2026, CMS has issued civil monetary penalties to 27 hospitals since enforcement began in June 2022. CMS issued 2,291 warning notices and 1,331 correction action plan requests during that same period, meaning the vast majority of noncompliant hospitals received warnings but not fines.
What was the largest hospital price transparency fine?
The largest fine to date is $979,000, issued to UF Health North in Jacksonville, Florida. The second-largest is $883,180, issued to Northside Hospital Atlanta in Georgia. Both penalties reflect extended periods of noncompliance calculated against the hospital's daily bed-based penalty rate.
Can hospitals appeal price transparency fines?
Yes. As of early 2026, 11 of the 27 fined hospitals had appeals under review. Beginning January 2026, hospitals can also receive a 35% reduction in their fine by waiving their right to a hearing within 30 calendar days of receiving the CMP notice. CMS can deny this discount if the hospital completely failed to post either the machine-readable file or the shoppable services list.
What changed in hospital price transparency rules for 2026?
Three major changes took effect January 1, 2026, with enforcement starting April 1, 2026: (1) hospitals must calculate pricing from 12 to 15 months of actual claims data rather than estimates; (2) hospitals must publish median, 10th percentile, and 90th percentile allowed amounts; and (3) a hospital CEO or designated senior official must sign an attestation that the data is accurate. The rule eliminated placeholder values that hospitals had been using to technically comply while publishing meaningless data.
How can I find my hospital's price transparency file?
Go to your hospital's website and look for a link in the footer labeled "Price Transparency," "Standard Charges," or "Machine Readable File." CMS requires all hospitals to include this link prominently. You can also search CMS's hospital price transparency data at data.cms.gov.
What should I do if my hospital bill seems too high?
Compare your bill to your insurer's Explanation of Benefits (EOB) and your hospital's published negotiated rate for the same procedure code. If the amounts don't match, contact your insurer's member services department to dispute. Upload your hospital bill to the free CoveredUSA Bill Analyzer. It compares your charges to Medicare benchmarks and publicly available pricing data to flag potential overcharges in about 30 seconds.
Are small hospitals also fined for price transparency violations?
Yes. Nine of the 27 hospitals fined through early 2026 had 30 or fewer beds, including four of the 10 hospitals fined in 2025. Small hospitals face a lower daily maximum ($300/day vs. $10 per bed for larger facilities), which explains why their fines tend to be lower, but CMS applies the same enforcement process regardless of hospital size.
Is there a difference between the machine-readable file and the shoppable services list?
Yes. The machine-readable file (MRF) is a comprehensive data file listing charges for all items and services. It can contain thousands of rows and is intended for use by researchers, employers, and developers. The shoppable services list is a simpler consumer-facing display of the 70 CMS-specified services plus at least 230 additional common services that patients frequently shop for. Hospitals must post both. Failing to post either one can disqualify the hospital from the 35% fine reduction available as of 2026.
Sources: CMS Hospital Price Transparency Enforcement Actions | CY 2026 OPPS Final Rule Fact Sheet | Becker's Hospital Review: 2025 Enforcement Data | CMS Hospital Price Transparency Data
