Florida Attorney General James Ulthmeier has taken action against several hospital systems in his state, including subpoenas, to ensure they are complying with President Donald Trump’s executive order requiring hospitals to provide “clear, accurate and actionable health care pricing information.”
Ulthmeier issued subpoenas on May 30 to Southern Baptist of Florida and AdventHealth, the Orlando Sentinal reported. In 2023, the Centers for Medicare and Medicaid Services (CMS) fined two more systems—Miami-based Jackson Memorial Hospital and Jacksonville-based UF Health North for alleged price transparency violations, according to Becker’s Hospital Review.
Florida is the first state to issue subpoenas in response to Trump’s EO issued on February 25. The subpoenas are part of an investigation by Florida’s attorney general’s office into hospital billing practices, a matter of heightened concern in a state whose extraordinary number of retirees requires frequent hospitalization.
“For years, many hospitals have extorted patients who have come in with life-or-death cases and left with crippling debt,” Ulthmeier said in a video on X. “Florida is not going to sit by on the sidelines.”
EO Resistance
Price transparency has been a concern since at least Trump’s first term. A first-term Trump EO on price transparency went largely ignored, write Aloke S. Chakravarty and Bunyad Bhatti in a legal analysis of Trump’s second EO on the matter.
“It has been widely reported that healthcare pricing has been opaque, with negotiations between providers, insurers, and drug companies taking place behind closed doors,” stated the analysis. “Many parties involved have resisted transparency efforts, arguing that confidentiality is necessary for maintaining competitive pricing.”
Fines, Penalties, Audits
Failure to change those pricing practices could lead to stiff fines against hospitals, including administrative penalties. “CMS will ramp up enforcement and impose fines that could escalate with repeated violations,” states the analysis. “Hospitals and insurers failing to meet transparency requirements can expect more-aggressive audits and higher monetary penalties.”
The Department of Justice and state attorneys general could also pursue civil litigation against noncompliant organizations, potentially resulting in lawsuits, injunctive relief, and financial settlements.
“Past enforcement trends suggest that major health systems could be targeted for high-profile legal actions,” states the analysis.
Practices could also be subject to criminal liability. “Persistent and deliberate noncompliance, particularly if tied to fraudulent reporting or intent to mislead consumers, could lead to criminal investigations under federal fraud and the False Claims Act (FCA),” states the analysis. “Executives and compliance officers should be aware of heightened scrutiny regarding data accuracy and disclosure practices.”
Price Checks
Trump’s EO directs federal agencies to make sure hospitals and insurers disclose “actual prices, not estimates.” Florida law forbids deceptive or omitted pricing. Ulthmeier’s subpoenas demand information about patient charges, billing practices, price transparency, and surprise billing protections.
“The big health care industrial complex continues to rake in billions off Americans in their most vulnerable moments,” said Uthmeier.
Price Transparency Sweep
The Trump EO has prompted actions in other states.
Patient Rights Advocate, an organization that tracks hospital price transparency, cites several examples, including a bill recently approved by the Oklahoma Senate to codify the price transparency regulations in the Trump EO.
Similar bills have been introduced in North Carolina and Wyoming. The North Carolina bill was passed by the state Senate.
In New York, lawmakers are revising a law that would have prohibited hospitals and health care practices from requiring patients to sign “consent to pay” forms before receiving treatment. State officials have said they will not enforce the statute until they understand the legislature’s intent.
Congressional Action
A bipartisan bill, introduced in Congress on July 17 by Sens. Roger Marshall, M.D. (R-KS) and John Hickenlooper (D-CO) would codify the Trump executive order as enforceable law.
The “Patients Deserve Price Tags Act” would require hospitals, ambulatory surgical centers, imaging providers, and clinical labs to post their actual negotiated rates, cash prices, and itemized costs.
The bill would also require itemized bills for health plans from providers, to give patients more information on what they are expected to pay.
Hidden Prices
Hospitals must end murky pricing practices, says Cynthia Fisher, founder and chairman of Patient Rights Advocate.
“As long as prices have been hidden, hospitals have been able to charge whatever they want,” said Fisher. “The Florida attorney general’s action seeks to protect patients through actual, upfront prices.
“This investigation protects patients from hospitals’ predatory practices, prevents overcharges, and makes bills accountable,: said Fisher. “Ultimately, these protections will help consumers lower their costs.”
Personal medical debt is why consumers, advocates, state legislators, an attorney general, and a president are making this issue front and center, says Craig Rucker, president of the Committee for a Constructive Tomorrow.
“Hospital stays invariably involve some discomfort, and patients of moderate means have always had anxiety about paying for their treatment,” said Rucker. “But the widespread practice of surprise billing has become something of a disease itself. Playing nice hasn’t worked. That’s why Trump’s executive order and Florida’s subpoenas are welcome.
“Hospitals need to change their ways, and they aren’t going to do it voluntarily,” said Rucker.
Bonner Russell Cohen, Ph.D. ([email protected]) is a senior fellow at the National Center for Public Policy Research.
Bonner R. Cohen is a senior fellow with the National Center for Public Policy Research, a position he has held since 2002.
