The Price Transparency Law Has No Teeth. By Design.
Five years of grace, 27 fines, and a penalty that started smaller than a rounding error. That is not an accident.
Last week, Health and Human Services (HHS) posted a stop sign.
THE GRACE PERIOD HAS ENDED.
The rule took effect five years ago.
Five.
IN TODAY’S ARTICLE:
Why a five-year “grace period” is a green light, not a deadline
The maximum fine that started at $110,000, for a hospital collecting billions
The 27 fines, across two presidents, that prove the law was never built to bite
What the dark actually costs you, in dollars
Glossary at the bottom of today’s article.
THE STOP SIGN
Last week the Department of Health and Human Services posted a stop sign on X. THE GRACE PERIOD HAS ENDED. Under it, a MAHA one-pager. Post your real prices. Comply with federal law. Hospitals that keep hiding prices will face consequences. More than 500 facilities notified. Fines up to $2 million. No further extensions.
Strong words.
Let’s test them.
The Hospital Price Transparency rule took effect on January 1, 2021.
The consequences HHS is now promising started April 1, 2026.
Count the years.
Five (5).
For five years the law sat on the books. For five years hospitals collected from you without telling you the price first. And for five years the agency that was supposed to enforce it treated the deadline like a suggestion.
That is not a grace period.
That is a green light.
THE PENALTY THAT STARTED AT NOTHING
Here is the detail that tells you everything about how serious Washington was.
When the rule went live on January 1, 2021, the penalty for breaking it was $300 a day. Flat. The same for every hospital in America. A rural 15-bed facility and a 900-bed flagship that collects billions in revenue faced the same fine. For a full year of hiding every price, the most any hospital could be made to pay was about $110,000.
A hundred and ten thousand dollars. For a giant system, that is not a penalty. That is a line item. You could break this law on purpose, all year, every year, and a hospital accountant would not feel it.
So hospitals did. By early 2021, CMS found that only 27 percent of hospitals were fully complying. By June of 2022, more than half of the country’s Medicare-certified general hospitals, 55 percent, still had not posted a usable file with their commercial negotiated prices. The law existed. The hospitals read the fine. They did the arithmetic. They stayed in the dark.
Only then, almost a year in, did CMS raise the stakes. Beginning January 1, 2022, the penalty increased to $10 per bed per day, up to $5,500 per day for the largest hospitals. For a full year, the new maximum reached $2,007,500. The minimum stayed at $109,500.
That is the number HHS now brags about on a stop sign. Two million dollars. Hold it against the defendants.
THE MATH
CommonSpirit Health is a nonprofit.
It runs 137 hospitals across 24 states.
In fiscal 2024, it collected $37.5 billion.
Run the division. The maximum fine for hiding every price, all year long, equals about 28 minutes of CommonSpirit’s revenue. Less than half an hour. For a violation that runs 365 days.
A $2 million cap against an operation collecting tens of billions is not a deterrent. It is a parking ticket on a Brinks truck. And remember, that ceiling only exists for the very largest hospitals. For most of the country, the maximum is far lower, and for the first full year of the rule, it was that flat $110,000 for everyone.
The penalty was never set to stop the behavior. It was set to be survivable.
Every health system has a press release about price transparency.
The Rojas Report has the fine count.
Twenty-seven in five years tells you which one to trust.
