In November 2024, the Department of Health and Human Services Office of Inspector General (OIG) published the results of its audit assessing hospital compliance with the federal Hospital Price Transparency Rule (HPT Rule). OIG determined that 37 out of the 100 hospitals sampled failed to comply with some element of the HPT Rule’s publicly available charges requirements.

As a reminder, the HPT Rule requires hospitals to make certain pricing information publicly available and easily accessible on their websites to increase competition and reduce the cost of health care. The HPT Rule is enforced by the Centers for Medicare & Medicaid Services (CMS).

Under the HPT Rule, hospitals are obligated to (1) publish a comprehensive machine-readable file that includes a list of standard charges for all items and services and (2) display a list of CMS-specified shoppable services in a consumer-friendly format; this requirement may be met by using an online price estimator tool allowing consumers to obtain free estimates for up to 300 shoppable services. The 37 noncompliant hospitals identified in the audit failed to comply with either one or both of the foregoing requirements.

Specifically, OIG found that:

• “34 hospitals did not comply with one or more of the requirements associated with publishing comprehensive machine-readable files;” and
• “14 hospitals did not comply with one or more of the requirements associated with displaying shoppable services in a consumer-friendly manner.”

Based on the audit results, OIG estimates “that 46% of the 5879 hospitals that were required to comply with the HPT rule did not comply with the requirements to make information on their standard charges available to the public.”

In response to its findings, OIG provided CMS with specific recommendations on increasing compliance with the HPT Rule. The report indicated that CMS concurred with all recommendations and proposed corrective actions. The recommendations included the following:

• Reviewing the specific hospitals identified by OIG as potentially noncompliant and pursuing enforcement measures if CMS determines such hospitals are out of compliance with the HPT Rule;
• Considering changes proposed by hospitals to clarify aspects of the HPT Rule, such as providing written guidance on the definition of “shoppable services” and developing training and compliance programs tailored for small hospitals; and
• Continuing to strengthen internal CMS controls, including allocating sufficient internal resources to monitor hospital compliance with the HPT Rule.

This OIG audit report and its affirmative direction to CMS to step up enforcement efforts demonstrates that HPT Rule enforcement remains a priority of regulators. According to the report, CMS has already initiated compliance reviews of certain hospitals included in OIG’s sample. Hospitals would, therefore, be well-advised to review the report closely, to assess their current compliance with the HPT Rule, and to consider proactive efforts to ensure continued compliance with the HPT Rule’s requirements. Notably, CMS created an online tool to aid hospitals in determining if their files are compliant with the HPT rule.

Additional Author: Paul Palma