The Federal Trade Commission warned 24 health systems Oct. 5 that incomplete or misleading price disclosures could violate federal consumer protection law, even if they meet CMS price transparency rules.
The FTC said omitting physician or facility fees could mislead patients about the total cost of care. The agency did not name the systems that received the letters.
The FTC action is the latest federal warning on hospital pricing in a year of few penalties. The administration has sent price transparency warning letters to 519 hospitals since April but has fined just one in 2026.
Warnings by the numbers
The administration sent warning letters to 519 hospitals for failing to provide transparent pricing information, according to a June Associated Press report. Hospitals in every state except Alaska received at least one letter.
- Texas had the most hospitals warned, with 42.
- California followed with 38.
- Indiana had 34.
- St. Louis-based Ascension had 13 hospitals across multiple states receive letters.
By contrast, CMS has fined one hospital in 2026. Pinnacle Hospital in Crown Point, Ind., was fined $51,615 on Feb. 4 for 155 days of noncompliance. The fewer-than-30-bed hospital was the 28th facility fined since the rules took effect Jan. 1, 2021. Pinnacle drew a second penalty of $40,356 in June for continued noncompliance, bringing its total to $91,971.
That pace trails 2025, when CMS fined 10 hospitals, with penalties ranging from $32,301 to $309,738. CMS fined three hospitals in 2024.
The 28 hospitals fined to date are spread across 16 states and Puerto Rico. Fines range from $32,301 for Southeast Regional Medical Center in Kentwood, La., to $979,000 for UF Health North in Jacksonville, Fla.
Stricter rules, delayed enforcement
The warnings follow President Donald Trump’s February 2025 executive order directing stronger price transparency enforcement, and a new set of requirements finalized in the 2026 outpatient payment rule.
Under that rule, hospitals must post actual prices rather than estimates and include median, 10th percentile and 90th percentile allowed amounts in their machine-readable files. They must also attest that the data is “accurate, complete and current,” name a CEO, president or equivalent executive accountable for the data, and report Type 2 national provider identifiers.
The requirements took effect Jan. 1, but CMS delayed enforcement until April 1. Hospitals that waive their right to an administrative law judge hearing within 30 days of a penalty notice can get a 35% penalty reduction. The reduction doesn’t apply to penalties for failing to post a machine-readable file or a consumer-friendly list of shoppable services.
Hospitals: Technical, not pricing, problems
Several hospitals that received warnings told Becker’s the issues CMS flagged were clerical or formatting errors, not missing prices.
- Allegheny Health Network (Pittsburgh): A spokesperson said “the only issue raised by CMS was not a transparency issue, it was a small technical/clerical issue” — omitting its legal entity name from the file. The system received written confirmation in May that CMS approved the fix.
- ECU Health (Greenville, N.C.): Notices went to ECU Health Medical Center and ECU Health Beaufort Hospital over machine-readable file formatting and complications tied to its organizational structure.
- Lompoc (Calif.) Valley Medical Center: Jeremy Farnum, director of information services, said the hospital had encoding errors in its machine-readable file but no missing pricing data. It corrected the three errors and prepared a corrective action plan.
- Universal Health Services (King of Prussia, Pa.): A spokesperson said “the primary issue that has been raised was a technical one dealing with the manner in which our facilities were identified.”
What’s next
More requirements could be coming. In its proposed 2027 outpatient payment rule, CMS sought comments on tightening machine-readable file standards, including how hospitals report outlier payments, stop-loss provisions, rate tiering and carve-outs. The agency also asked whether to modify or eliminate deemed compliance for online price estimator tools.
