WASHINGTON, D.C. – Attorney General Karl A. Racine today called on 11 hospitals throughout the District to fully comply with new federal hospital regulations that went into effect earlier this year that aim to make the pricing of medical services more transparent and accessible to consumers. 

He specifically requested the hospitals detail how they are abiding by new federal regulations that require hospitals to publicly disclose and display their price lists online for shoppable services in a manner that consumers can easily access and navigate. These regulations aim to help consumers understand pricing of services at hospitals—a serious concern for consumers. The lack of price transparency has also been shown to increase health care costs generally. AG Racine’s outreach to the hospitals follows news reports that several hospitals throughout the country including hospitals in the District, failed to comply with the federal hospital pricing transparency regulations including by blocking information on pricing from web searches or on their websites. 

“When consumers need critical medical care, they should know exactly what that care will cost them – and it’s up to hospitals to work in consumers’ best interest to make that pricing easily available. We want to make sure District hospitals are complying with new federal regulations that require hospitals to be more transparent with consumers about the cost of services,” said AG Racine. “Especially as health care costs continue to rise and news reports have detailed some hospitals across the country purposely hiding prices from consumers, it is essential for our hospitals to be clear and direct about their costs.”   

In a letter to District hospital administrators, AG Racine emphasized how crucial price transparency is for consumers, and how by failing to comply with the federal regulations, hospitals may be violating the District’s Consumer Protection Procedures Act, which prohibits a wide variety of deceptive and unfair business practices. He specifically requested they respond detailing how their hospitals are complying with the federal regulations.

A copy of the letter AG Racine sent today to the 11 District hospitals is available here and the full text is below.  

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Dear Hospital Administrator, 

The District of Columbia Office of the Attorney General (“OAG”) is committed to ensuring that consumers seeking medical treatment have accurate and complete information about the services they require. As one example, after learning of serious inaccuracies in mental health directories, in 2018, OAG entered into settlements with several health insurance companies to ensure that consumers have accurate information about mental health care providers.[1] We know that price transparency is a serious concern for consumers. Consumers seeking medical treatment often have little, if any, information about the price of services they are told they require. This lack of price transparency not only creates anxiety for consumers, who are already facing stressful medical situations, but it also has been shown to increase health costs generally.[2] 

On January 1, 2021, federal hospital pricing transparency regulations went into effect. Those regulations require that hospitals make publicly available a machine-readable file containing a list of prices for all items and services as well as a consumer-friendly list with prices for shoppable services. 45 C.F.R. § 180.40. For each item or service, both lists must include the hospital’s chargemaster price, its cash-discount price, all payer-negotiated prices, and the minimum and maximum payer-negotiated prices. Id. § 180.20. In lieu of a consumer-friendly list of shoppable services, a hospital may instead make available an online cost-estimator tool. Id. § 180.60(a)(2). 

The federal regulations require that this information be “displayed in a prominent manner” on the hospital’s website and that it be “easily accessible, without barriers.” Id. § 180.50(d). To this end, the information must be available free-of-charge, without requiring the registration of a user account, and—except as necessary to compute a price in the event the hospital uses a cost-estimator tool—without collecting personally identifiable information (PII). Id.; see also id. § 180.60(a)(2), (b). It also must be updated at least annually. Id. § 180.50(e), 180.60(e). 

OAG enforces the District’s Consumer Protection Procedures Act (“CPPA”), D.C. Code §§ 28-3901, et seq. Under the CPPA, it is illegal to violate other laws or regulations in the context of consumer transactions. Therefore, your compliance with these regulations is of significant interest to our office. Unfortunately, media reports have already indicated that a number of hospitals—including some hospitals and hospital systems in the District of Columbia—are not in full compliance.[3]

In order to independently assess whether District of Columbia’s hospitals are complying with the federal regulations, we ask that you provide us with the following information:  

1. the URL of the webpage containing the machine-readable list of all items and services described in 45 C.F.R. § 180.50;  
2. an explanation as to why (if applicable) a discounted price is either not provided or is listed as “N/A” on the list of items and services described in 45 C.F.R. § 1080.50;  
3. the URL of the webpage containing either: (a) the consumer-friendly list of shoppable services described in 45 C.F.R. § 180.60, or (b) the online cost-estimator tool described in the same section;  
4. an explanation of why, as to each webpage responsive to requests (1) and (3), you believe the information is “prominently displayed” on the hospital’s website, focusing in particular on ease-of-access to the information from the hospital’s “home” webpage; and  
5. whether the hospital employs emergency room doctors who are not in the insurance networks accepted by the hospital itself, and, if so, whether the hospital or those doctors bill patients at out-of-network rates;  
   1. if yes to the above, what if any disclosures are made to patients before entering the emergency room (on the website, etc.) or at the time of entering the emergency room. 

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[1] See https://oag.dc.gov/release/attorney-general-racine-announces-insurers-will 

[2]See Alex Kacik, Hospital Price Growth Driving Healthcare Spending, MODERN HEALTHCARE (Feb. 4, 2019), https://www.modernhealthcare.com/article/20190204/NEWS/190209984/hospital-price-growth-driving-healthcare-spending.  

[3] See Tom McGinty, Anna Wilde Mathews & Melanie Evans, Hospitals Hide Pricing Data from Search Results, WALL ST. J. (Mar. 22, 2021), https://www.wsj.com/articles/hospitals-hide-pricing-data-from-search-results-11616405402.