Every hospital price transparency fine CMS has issued, and what each hospital missed

What did CMS fine hospitals for?

The failures CMS cites have changed as the rule has changed. Several requirements began in 2024: the .txt file and the footer link from January 1, 2024, under 45 CFR 180.50(d)(6), and a file built on CMS's template, with the hospital's name, license number and locations encoded in it, from July 1, 2024. The .txt file sits in the root folder of the website that hosts the price file and gives the location name, the page that links the file, the file's own address and a contact.

The 12 notices from 2022 and 2023 most often cited missing files and lists, charges left out of the file, and file names. The requirements that began in 2024 appear in 13 of the 14 notices dated December 2024 or later. None of those 14 cites a charge left out of the machine-readable file or a file name. The median notice cited 3 requirements, and the range was 1 to 7.

Fifteen of the 27 notices cited a missing file, a missing list or both. The other 12 cited problems with a file or list the hospital had posted, or with how its website pointed to them.

Did every fined hospital get a warning first?

No. For 13 of the 26 fined hospitals, CMS's first letter was a notice of violation that asked for a corrective action plan, a written plan to fix the problems by a deadline, which CMS calls a CAP request. The other 13 got a warning notice first.

CMS said in an April 26, 2023 fact sheet that for hospitals that "have not posted any machine-readable file or shoppable services list/price estimator tool," it "will no longer issue a warning notice to the hospital and will instead immediately request that the hospital submit a CAP." Of the 16 fined hospitals whose first letter came after that date, 13 got a CAP request first.

The penalty notices show what those 13 first letters said. Each one said CMS had found no machine-readable file, no consumer-friendly list, or neither: 6 letters said CMS found neither, 4 found no file, and 3 found no list.

How long did hospitals have before the fine?

The first penalty notice came 68 to 626 days after CMS's first CAP request, with a median of 164 days across the 26 hospitals. Counted from CMS's first letter of any kind, the range was 68 to 728 days. For the 13 hospitals that got a warning first, 99 to 434 days passed between the warning and the CAP request, with a median of 157.

The same April 2023 fact sheet describes two deadlines after a CAP request. It says CMS "will continue to require hospitals that are out of compliance with the hospital price transparency regulation to submit a CAP within 45 days from when CMS issues the CAP request," and will now require them "to be in full compliance with the hospital price transparency regulation within 90 days from when CMS issues the CAP request." For the 16 hospitals first written to after the fact sheet, the first fine came 68 to 626 days after the first CAP request, with a median of 157.5 days.

How did CMS set the amount of each fine?

Every one of the 27 fines was charged at the maximum daily amount in force on the first day the notice counts, by Kent Applied's check of each notice's arithmetic. A notice multiplies a daily amount by the days it counts. Under 45 CFR 180.90, the daily maximum was $300 for every hospital in 2021. From 2022 it depends on the bed count: $300 a day for a hospital with 30 or fewer beds, $10 a day for each bed at a hospital with 31 to 550 beds, and $5,500 a day above 550 beds. The maximums are adjusted for inflation in 45 CFR 102.3, and the notices used the adjusted amounts in force on the first day each counts: $323, $11 and $5,926 from October 6, 2023, $333 and $11 from August 8, 2024, and $342 from January 28, 2026. In 5 notices, a higher adjusted maximum had taken effect by the notice's own date. The bed count comes from "the most recently available, finalized Medicare hospital cost report."

Arkansas Methodist Medical Center's notice of May 13, 2025, shows how the parts fit. CMS counted 114 beds, so the daily maximum was $11 a bed, or $1,254 a day. It counted 247 days, from September 9, 2024, to the date of the notice: $11 x 114 beds x 247 days = $309,738.

The notices counted 70 to 398 days, with a median of 182. The three largest fines came from a large bed count or a long period. The largest, $883,180, charged $10 for each of 536 beds for 158 days of 2022, plus $300 a day for 121 days of 2021. The second, $871,122, charged $5,926 a day for 147 days at a hospital with more than 550 beds. The third, $847,740, charged $10 for each of 213 beds for 398 days.

In 7 of the 26 first penalty notices, the days counted start later than the date CMS gives for the start of noncompliance. The two 2022 notices start at a September 2021 review. Five notices from December 2024 to February 2025 start in July or August 2024, near a later review or a new CAP request, 389 to 538 days after the date CMS gives for the start of noncompliance.

Since January 1, 2026, a hospital that waives its right to a hearing, in writing within 30 days, gets 35 percent off the penalty, unless the fine is for a missing file or list, under 180.90(c)(4). Both 2026 notices, February 4 and June 3, describe the offer, and both cite a missing file or list.

What does "under review" mean, and how have appeals ended?

"Under review" means the hospital asked for a hearing. Today the page marks 3 notices that way, with a footnote to 45 CFR 180.90(e)(2)(i). Sixteen Internet Archive copies of the same page, captured from September 2023 to October 2026, show the mark more widely: 21 of the 28 hospitals on the list were marked in at least one of the 17 copies, counting today's page.

The HHS Departmental Appeals Board has posted four decisions on hospitals on CMS's list, by its administrative law judges, who hear these appeals. Two upheld the penalty in full: Kell West Regional Hospital, $117,260, decided January 4, 2024, and Fulton County Hospital, $63,900, decided September 10, 2025. Two upheld CMS's finding and cut the amount: Hospital General Castaner, from $101,400 to $33,800, on January 26, 2026, and Holy Cross Hospital, from $325,710 to $162,855, on February 5, 2026.

The rule says what follows a final and binding decision: a penalty upheld in full stays posted, one upheld in part gets a modified notice, and one overturned in full comes down. CMS's page, last changed June 11, 2026, still marks Hospital General Castaner under review and links the original $101,400 notice. Holy Cross Hospital's entry now links a notice of resolution.

What happened to the two fines CMS later resolved?

For two hospitals on its list, CMS now posts only a notice of resolution, which states no amount. Archived copies of CMS's page from September 2023 to March 2024 list them at $979,000 for UF Health North and $325,710 for Holy Cross Hospital. The original notices, also in the Internet Archive, show the arithmetic (UF Health North, Holy Cross Hospital): $5,500 a day for 178 days, and $10 for each of 423 beds for 77 days. The page dropped its amount column in 2024, so a reader now has to open each notice to see what CMS charged. The 27 fines and $4,938,685 in this report leave both out.

What happens to a case after the fine?

CMS's enforcement dataset records a closure notice after the fine for 25 of the 26 fined hospitals. Its data dictionary defines a closure notice as "CMS determined that the hospital corrected previously identified deficiencies." The closures came 8 to 425 days after the first fine, with a median of 55. The 26th case ended in an administrative closure.

How often does a case end in a fine?

A fine came in 28 of the 1,788 cases with a CAP request in CMS's dataset, or 1.6%. The dataset holds 8,038 cases from January 2021 to July 31, 2026. In 3,620 of them, a review found no problems, and in 4,335, CMS sent a warning notice, a CAP request or both. The 28 that reached a penalty notice are one for each hospital on CMS's list. Another 1,652 were closed after the hospital fixed the problems, and 108 were still open on July 31, 2026. CMS's methodology says the dataset "may not reflect all enforcement activities undertaken by CMS since January 1, 2021."

Where are the fined hospitals?

The fined hospitals are in 15 states and Puerto Rico. Texas has the most penalty notices, with 5, and Louisiana is next with 3. Alabama, Arkansas, Georgia, Indiana and Puerto Rico have 2 each, and Indiana's 2 went to one hospital.

What can a hospital check before a letter from CMS arrives?

Start with the fact that a warning may not come. For 13 of the 26 fined hospitals, the first letter was a CAP request. CMS's fact sheet gives a hospital "a 45-day deadline for hospitals to submit a CAP" after that request. These are the checks, in the order the notices cite them most, each with its section of the rule and CMS's free tool where one exists. CMS's resources page links the tools.

1. A .txt file in the root folder of the website that hosts the price file, with the location name, the page that links the file, the file's address and a contact, under 180.50(d)(6)(i). CMS offers a TXT File Generator.
2. A machine-readable file that is posted at all, under 180.40(a), and a consumer-friendly list of at least 300 shoppable services (or every one it provides, if fewer) or a price estimator that gives an actual estimate, under 180.60(a).
3. A file built on CMS's template, under 180.50(c)(2). CMS's validator "tests against the required CMS template and data specifications."
4. The hospital's name, license number, locations and addresses in the file, and since January 1, 2026 its Type 2 National Provider Identifier, the number that identifies the organization, under 180.50(b)(2)(i)(A).
5. A "Price Transparency" link in the website footer, under 180.50(d)(6)(ii).
6. The file name CMS specifies, under 180.50(d)(5). CMS offers an MRF File Naming Wizard.
7. An update at least once a year, with the date shown, under 180.50(e) and 180.60(e).
8. The attestation and the name of the CEO, president or senior official responsible for the file, under 180.50(a)(3)(iii) and (iv). These took effect on January 1, 2026, and CMS put off enforcing them until April 1, 2026. No notice posted so far cites them.

Then make sure CMS's mail reaches someone who will act on it. The rule says CMS sends a penalty notice "via certified mail or another form of traceable carrier." Each of the 27 penalty notices opens with a letter to a named person at the hospital. In one appeal decision, the judge wrote that "if Respondent's staff had responded to the CAP notice letter or the multiple phone calls from CMS, the issue may have been resolved before a CMP was ever imposed."

For a hospital that would rather have these checks run for it, Kent Applied's Price Transparency and Accessibility Monitor checks a sample of the prices in the posted file against the chargemaster every week, and checks the website against HHS's accessibility rule. It costs from $9,500 + $450 a month, and the first step can be a hospital audit of one hospital's price file and top web pages, for $3,500 ($7,500 to cover every website a health system runs).

Price transparency fines also appear among the healthcare problems AI tools can work on without patient data and on the community hospital card in where AI tools fit in healthcare, by kind of organization.

How we did this

Kent Applied read every document linked from CMS's enforcement actions page, which was last modified June 11, 2026, and was read again on October 17, 2026: 27 penalty notices and 2 notices of resolution. For each penalty notice we recorded the date, the amount, the earlier letters the notice lists with their dates, and each failure CMS cited at its last review before the notice, with the section of 45 CFR part 180 the notice gives for it.

The failures were sorted into 13 requirements by their plain-words description. The grouping follows the meaning, not the section number, because the rule's numbering changed on July 1, 2024: before that date, 180.50(b)(2) was the gross charge, and since then, 180.50(b)(2)(i)(A) is the hospital's name and license. A notice counts once for each requirement it cites. The downloads keep every section as cited.

For the arithmetic, we copied from each notice the date CMS gives for the start of noncompliance, the first and last day counted, the days, the daily amount and the bed count. The method script reproduces every total to the cent and checks that each daily amount equals the maximum in force on the first day counted, from 180.90(c) and the 102.3 tables in force from October 6, 2023, August 8, 2024 and January 28, 2026.

Each fined hospital's timeline runs from its first penalty notice: the first finding, the warning notice, the CAP requests and the fine. The closure date comes from CMS's enforcement dataset, the July 2026 file published August 14, 2026, matched by the penalty date and the hospital's name. Days are calendar days, the later date minus the earlier. For the 13 hospitals whose first letter was a CAP request, we read each notice's account of that letter.

The case counts use every Case_ID in the dataset, placed by the strongest action the case holds and whether it ends in a closure. One hospital can have several cases.

The under-review history rests on 16 Internet Archive copies of CMS's page and the live page, so 21 of 28 is a floor. The archive is a copy of CMS's own page. The appeal decisions were found by searching the Appeals Board's decisions for 2023 to 2026 for each hospital on the list. One listing appeared on CMS's page in September 2023 and was gone three weeks later; it is in no count.

Three choices affect single dates. One notice prints a first-review date a year before every other date in its own account (June 14, 2022, against noncompliance since June 14, 2023), and the timeline uses the 2023 date. In 3 notices the days counted are one fewer than the dates give when both ends are counted; we use each notice's own days. The dataset dates one warning notice December 21, 2022, and the notice says December 22; the timeline uses the notice.

Amounts are what CMS imposed. The notices do not say what any hospital paid.

Questions and answers

Is a CMS penalty notice the same as a warning notice?

No. A warning notice and a CAP request ask a hospital to fix what CMS found. A penalty notice imposes a civil monetary penalty, which the rule lets CMS do when a hospital fails to answer a CAP request or to carry out its plan. The rule also has CMS post every penalty notice on a CMS website.

How many cases include a warning notice or a CAP request?

Of the 8,038 cases in CMS's enforcement dataset from January 2021 to July 31, 2026, 4,335 include a warning notice, a CAP request or both. These are cases, and one hospital can have several. CMS says the dataset may not reflect all of its enforcement activities.

Has anyone else counted these fines?

Yes. GAO reported in October 2024 that "from 2021 through 2023, CMS issued more than $4 million in civil monetary penalties to 14 hospitals." GAO does not name the 14. CMS's page now lists 12 penalty notices dated 2022 and 2023.

Can a fine shown here still change?

Yes, for First Surgical Hospital and Samaritan Hospital - Albany Memorial Campus, which CMS marks under review and which have no posted decision. A judge cut Hospital General Castaner's penalty to $33,800 on January 26, 2026, and CMS's page still marks it under review. Under 45 CFR 150.453, a judge's decision "is final and appealable after 30 days unless it is modified or vacated."

Where is the data?

The explorer above lists every hospital, and the downloads below hold every table, free to reuse with credit under CC BY 4.0.