The Centers for Medicare & Medicaid Services (CMS) recently released its latest report on enforcement and complaint data related to Title XXVII of the Public Health Service Act, which encompasses the surprise billing and price transparency provisions of the No Surprises Act.
As of June 30, 2024, CMS has received over 16,000 complaints. The agency has resolved 12,700 of these cases, with 400 involving violations of Public Health Service (PHS) regulations. Notably, CMS has secured more than $4 million in restitution for closed cases.
Key Findings:
- Plan Issuers: The most common complaints include non-compliance with Quality Payment Amount requirements, delays in payment following independent resolution determinations, and failures to adhere to 30-day payment or notice of denial requirements.
- Providers: The primary issues involve surprise bills and discrepancies in good faith estimates.
This report underscores CMS’s ongoing commitment to enforcing the No Surprises Act and addressing violations to ensure compliance and protect consumers.
