In an Aug. 20 report, the Centers for Medicare & Medicaid Services (CMS) provided detailed data on complaints and enforcement efforts related to title XXVII of the Public Health Service Act that includes the surprise billing and price transparency provisions of the No Surprises Act.
CMS reports that as of June 30, the agency had received 16,073 complaints, 12,077 of which were related to No Surprises Act compliance. Of these complaints, 10,300 were made against providers, facilities, and air ambulance services, while the other 1,777 complaints were made against nonfederal government plans and issuers. The agency reports it has closed 12,700 complaints.
“Through the CMS investigation process, CMS has directed plans, issuers, providers, health care facilities, or providers of air ambulance services to take remedial and corrective actions to address instances of noncompliance,” the agency writes in the report, “which has resulted in approximately $4,183,383 in monetary relief paid to consumers or providers.”
The complaints against providers most frequently related to surprise billing for nonemergency services at an in-network facility (4,286 complaints), surprise billing for emergency services (2,577 complaints), and good-faith estimates (1,922 complaints).
The most frequent complaints against plan issuers were noncompliance with Quality Payment Amount requirements (1,035 complaints), late payment after independent dispute resolution determination (675 complaints), and noncompliance with 30-day initial payment or notice of denial payment requirements (390 complaints).
Sources:
https://www.cms.gov/files/document/august-2024-complaint-data-and-enforcement-report.pdf
