Hospital price transparency
How CMS enforcement works, step by step
CMS enforcement begins with an assessment of the hospital disclosures, not with a private validator score. Under 45 CFR 180.70, CMS can evaluate complaints, review outside analyses, conduct audits and comprehensive reviews, request an authorized official's certification, and request supporting documentation.
If CMS concludes a hospital is noncompliant, it may issue a written warning notice, request a corrective action plan for a material violation, or impose a civil monetary penalty when the hospital fails to respond to a CAP request or comply with a CAP. The regulation says these actions generally, but not necessarily, occur in that order. A warning is not guaranteed in every case.
CMS's April 2023 process update says hospitals that have made no attempt to satisfy the disclosures can receive a CAP request without an initial warning. The same update sets a 45-day CAP submission policy and a 90-day compliance policy measured from the CAP request. The hospital must read its actual notice for the required form, manner and deadlines.
A useful response record connects each cited requirement to the public page or file, the observed defect, the responsible owner and the evidence of correction. That is a recommended workflow. CMS, rather than the workflow or a software result, makes the enforcement determination.