The Trump administration is threatening to fine more than 500 hospitals up to $2 million a year each for refusing to post their prices publicly, enforcing a rule the Biden administration largely left on the shelf.
The Centers for Medicare and Medicaid Services has sent warning letters or compliance demands to more than 500 hospitals since April, according to a list the Associated Press obtained exclusively. The cited facilities face annual fines as high as $2 million for failing to post their pricing data in a usable public format. Daily penalties scale with hospital size, running $3,000 per day for a community hospital and $5,500 per day for a large health system, with no cap on the number of days those penalties accumulate.
The enforcement push traces to an executive order President Trump signed in 2019 during his first term, directing hospitals to make pricing data publicly accessible so patients and insurers can compare costs before seeking care. A senior administration official told the AP that hidden prices are a direct driver of inflated healthcare costs and that the new wave of letters is designed to close the enforcement gap that opened in the years since.
Texas leads the cited list with 42 hospitals receiving notices, more than any other state. Indiana had 34 facilities flagged, nearly matching California's 38 despite having one fifth the population. Florida, Alabama, and Louisiana were also among the states with high concentrations of warned hospitals, according to AP reporting. Ascension, a Missouri-based nonprofit and one of the country's largest hospital networks, had 13 of its facilities across multiple states receive warning letters.
This year's enforcement carries tougher standards than previous rounds. A rule finalized in November 2025 and effective January 1, with CMS enforcement beginning April 1, eliminated the use of estimated or placeholder pricing. The rule also requires a hospital's chief executive officer to personally certify that posted prices are "true, accurate, and complete." An executive who signs off on misleading data is now personally tied to the filing, raising the legal stakes considerably.
The Biden administration fined just 15 hospitals despite identifying 1,579 facilities out of compliance with the same price transparency rules, according to enforcement records cited by industry analysts. Patient advocacy groups criticized that posture at the time as too lenient to drive meaningful change. The difference between 15 fines over four years and 500-plus warning letters in roughly two months underscores how thoroughly accountability lapsed under the previous administration.
The 28 hospitals that have actually been fined to date show how large the penalties can grow. CMS records show UF Health North in Florida received the largest fine at $979,000. Northside Hospital Atlanta was fined $883,180, and Jackson Memorial Hospital in Miami received $871,122. None of those fines reached the $2 million annual ceiling, which the current warning letters now hold explicitly over every hospital that remains noncompliant.
Once a hospital receives a warning letter, it has 90 days to come into compliance. If it has not, CMS issues a corrective action plan demand with a 45-day deadline, and daily fines begin accumulating once a hospital fails to produce a credible plan. Administration officials told the AP that more letters are coming, meaning the count of 500-plus is a floor, not a ceiling.
For patients, the goal is straightforward: the ability to compare what different hospitals charge for the same procedure before scheduling care, rather than receiving a bill weeks after the fact. The administration has tied the transparency push to its broader effort to lower healthcare costs through market accountability rather than federal price controls. Whether hospitals fall into line quickly or challenge the fines in court, the enforcement record makes ignoring the rules far more expensive than it has been in years.
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