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CQC

@4qualitycare.bsky.social
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CQC @4qualitycare.bsky.social · 17h
Oklahoma is a microcosm of our healthcare affordability & access problems. The average Oklahoman has >$2,000 in medical debt. The state’s rural hospitals are set to close en masse, so as care gets more expensive, people will have a harder time accessing it. www.liveinsurancenews.com/oklahoma-hig...
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CQC @4qualitycare.bsky.social · 30/09/2026
AI tools deny treatment 16 times more often than human reviewers. Insurers are automating prior authorization to deny care faster. Banning prior authorization entirely is the only solution. Patients can't afford to wait for AI to decide their fate. www.psychologytoday.com/us/blog/the-...
psychologytoday.com
When AI Decides If My Patient Gets Their Medication
Insurance companies are using AI to deny care faster than ever before. A physician shares what that means for patients, physicians, and trust in medicine today.
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CQC @4qualitycare.bsky.social · 29/09/2026
Patients in NV can now use the Nevada Hospital Price Finder to compare procedure prices among local hospitals. Developed by Patient Rights Advocate, patients can finally have transparency and avoid surprise bills. www.reviewjournal.com/business/new...
reviewjournal.com
New database allows patients to see price differences among Las Vegas Valley hospitals
The Nevada Hospital Price Finder lets consumers compare hospitals’ reported cash price and rates negotiated with insurers for common procedures and other services.
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CQC @4qualitycare.bsky.social · 28/09/2026
The No Surprises Act’s IDR was intended to protect patients from surprise bills. Instead, the arbitration system has become so expensive and broken that employers are paying millions more, and workers are footing the bill through higher premiums. www.fiercehealthcare.com/regulatory/n...
fiercehealthcare.com
No Surprises Act IDR arbitration driving high costs for employers, new report finds
Self-funded employers are facing the brunt of costs associated with the No Surprises Act (NSA) arbitration process, a new report from the ERISA Industry Committee (ERIC)
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CQC @4qualitycare.bsky.social · 24/09/2026
Price transparency alert! Only 35% of OH hospitals are compliant with existing federal requirements, despite having 5 years to adjust. Even worse, only 6% of OH hospitals make sufficient pricing data available. Patients can't live in the dark. www.mahoningmatters.com/news/state/a...
mahoningmatters.com
Only half of U.S. hospitals complying with federal price transparency rules, Ohio lags behind national rate
Of the 79 Ohio hospitals reviewed in the report, 35% were compliant and just 6% met the report’s criteria for sufficient pricing data.
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CQC @4qualitycare.bsky.social · 23/09/2026
More hospitals are complying with price-transparency rules, but there’s still room for improvement. Roughly one-quarter of Nevada hospitals surveyed by PRA were found out of compliance. news3lv.com/news/local/r...
news3lv.com
Report: 75% of Nevada hospitals fully comply with federal price transparency rule
More Nevada hospitals are posting their full prices online as required under a federal transparency rule, according to a new report that examined compliance at
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CQC @4qualitycare.bsky.social · 22/09/2026
Wisconsin’s hospitals keep defying federal price-transparency rules, according to the latest Patient Rights Advocate report. But don’t worry! The lobbying org for the state’s biggest hospitals has assured us that everything is A-OK. Totally believable. www.wispolitics.com/2026/wha-den...
wispolitics.com
WHA denouncing ‘flawed’ hospital price transparency report
The Wisconsin Hospital Association is denouncing as “flawed” a new report from an advocacy group that found just 61% of the hospitals it assessed in Wisconsin are fully complying with federal price…
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CQC @4qualitycare.bsky.social · 16/09/2026
Medicare Advantage is one of the most data-rich programs in the federal government, and recent False Claims Act settlements show just how much fraud that data can hide. Overpayments drain the program while patients get squeezed on access. Oversight needs to catch up. www.jdsupra.com/legalnews/me...
jdsupra.com
Medicare Advantage Fraud Enforcement in 2026: What Recent Settlements Reveal About the Limits of Data-Driven False Claims Act Cases | JD Supra
Over the last several months, there has been no shortage of commentary about the Department of Justice’s (DOJ) Fraud Oversight through Careful Use of...
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CQC @4qualitycare.bsky.social · 15/09/2026
Another example of how consolidation raises costs: UnitedHealthcare pays doctors working for providers that it owns roughly 17% more than doctors working for independent providers. Same care. Just 17% more expensive, with patients footing the bill. www.thestreet.com/health/unite...
thestreet.com
https://www.thestreet.com/health/unitedhealth-optum-physician-acquisitions-medicare-spending-brown-study
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CQC @4qualitycare.bsky.social · 14/09/2026
Native American and Alaska Native patients are exempt from new Medicaid work requirements. Native Hawaiians are not, even though clinicians warn the same barriers to care apply. More than half of Native Hawaiians live outside Hawai'i, cut off from the systems built to serve them.
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CQC @4qualitycare.bsky.social · 10/09/2026
A family got awful news: stage 4 pancreatic cancer. Though the FDA recently approved a life-saving drug, the family’s insurance refused to cover it. It took >70 phone calls & 40 hours on the phone before their insurance would extend coverage to the drug. www.nbcrightnow.com/news/pasco-f...
nbcrightnow.com
Pasco family fights for cancer drug access after FDA approval
PASCO, Wash. — A Pasco family said getting a newly approved cancer drug has become its own battle as Juan Solano faces stage 4 pancreatic cancer.
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CQC @4qualitycare.bsky.social · 09/09/2026
A cancer patient's costs rose fivefold after his independent oncology practice was bought by a big hospital system. This is how industry consolidation works: same care, higher prices, more profits for big hospitals. www.usatoday.com/story/life/h...
usatoday.com
Cancer patients are seeing higher bills after clinics are bought out
More and more oncology clinics are being snapped up by hospitals, and it's resulting in much higher bills for those seeking care.
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CQC @4qualitycare.bsky.social · 08/09/2026
The PA debate isn’t simply about costs — it’s about saving lives. When insurers incorrectly label care, like PET scans for a Stage 4 cancer patient, as “not medically necessarily,” the delay can quite literally mean the difference between life or death. www.healthywomen.org/your-care/ca...
healthywomen.org
The Cost of Saying No: When Insurers Deny Critical Imaging Tests, Cancer Treatment Is Delayed
Imaging tests like PET scans save lives. So why are insurers frequently denying them?
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CQC @4qualitycare.bsky.social · 08/09/2026
Insurance companies when they say prior authorization isn't about padding their profits:
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CQC @4qualitycare.bsky.social · 07/09/2026
Vertical integration is ruining American health care. 90% of all beds are controlled by large hospital systems, and prescriptions are controlled by just 3 PBMs. The result? Rising treatment costs and growing levels of medical debt. www.star-telegram.com/news/busines...
star-telegram.com
Mark Cuban's new fight against healthcare companies: antitrust enforcement
Mark Cuban has been fighting the healthcare industry for years.
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CQC @4qualitycare.bsky.social · 04/09/2026
The American health care system is broken, but Congress can fix it. Common sense reform, through legislation like the Safe Step Act, removes PA and changes step therapy requirements, making care more accessible and less stressful for patients in need. infusionaccessfoundation.org/closing-the-...
infusionaccessfoundation.org
Closing the Gap: Why Infusion Patients Need Federal Step Therapy Reform | Infusion Access Foundation
Aug 28, 2026 | Policy Infusion
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CQC @4qualitycare.bsky.social · 04/09/2026
A year ago, insurers pledged to change prior authorization requirements for 80% of diseases and illnesses. Today, they have only been reduced by 11%. Voluntary pledges are politically expedient, but they rarely fix the problem. Regulators need to do more. www.mcknights.com/news/feds-he...
mcknights.com
Feds’ health industry deals haven’t been enforced and are at risk of vanishing
Administration-industry deals lack the enforcement teeth of more traditional federal regulation. Their details are vague, and minimal oversight makes it hard to monitor progress.
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CQC @4qualitycare.bsky.social · 01/09/2026
The codes on your medical bill are copyrighted. A patient advocacy group is now suing the American Medical Association, arguing it has no right to lock up the billing code system and charge for access. Patients shouldn't need a license to understand their own bill. shorturl.at/KOuXr
medpagetoday.com
AMA Sued Over Its 'Paywalled' Billing Codes
CPT codes should be free for clinicians and the public to read and use, advocacy group argues
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CQC @4qualitycare.bsky.social · 31/08/2026
A tumor diagnosis is terrifying. Finding out your insurer decided it doesn't count because they say it "existed before" your policy started? That's not an insurance system. That's a trapdoor. Patients are paying premiums for coverage that vanishes when they need it most.  shorturl.at/5I9SR
nbcnews.com
She thought she had insurance coverage. Then a tumor was flagged as a pre-existing condition.
Under the Affordable Care Act, insurers can’t deny coverage because of pre-existing conditions. But certain plans aren’t required to abide by the ACA’s consumer protections.
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CQC @4qualitycare.bsky.social · 30/08/2026
It’s not hard to understand why Medicare Advantage patients are increasingly distrustful of their insurers. When you deny coverage for needed care & create a thicket of red tape impeding patients from using their coverage, you’re going to lose their trust. www.medicaleconomics.com/view/medicar...
medicaleconomics.com
Medicare Advantage members are losing trust in their plans — and physicians are absorbing the fallout | Medical Economics
A new JD Power study shows satisfaction with Medicare Advantage falling for the second year in a row. For primary care physicians, the numbers explain a lot about what's landing on their desks.
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CQC @4qualitycare.bsky.social · 29/08/2026
Vertical integration and hidden fees allow large health companies to upcharge patients, leaving them with bills they cannot pay and sometimes preventing access to care entirely. We need more transparent prices in our healthcare system. kffhealthnews.org/health-care-...
kffhealthnews.org
Watch: Mark Cuban Says You Can’t Fix Healthcare Until Every Price Is Known - KFF Health News
With his online pharmacy, Mark Cuban changed how generic drugs are sold — and he has thoughts about how to fix the healthcare system. The billionaire businessman talks to KFF Health News’ Julie…
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CQC @4qualitycare.bsky.social · 28/08/2026
13% of prior-authorization denials for Medicare Advantage patients should have been approved, according to federal auditors. Yet another example of insurance companies using PA to boost their profits at the expense of consumers. www.beckershospitalreview.com/whitepapers/...
beckershospitalreview.com
https://www.beckershospitalreview.com/whitepapers/where-reimbursement-risk-really-starts-in-a-specialty-revenue-cycle/
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CQC @4qualitycare.bsky.social · 27/08/2026
According to a new report by KFF, at least 1 in 8 patients are denied care through Prior Authorization. For patients covered under the ACA Marketplace, the denial rate is 18%. www.healthleadersmedia.com/revenue-cycl...
healthleadersmedia.com
https://www.healthleadersmedia.com/revenue-cycle/new-pa-reporting-requirements-expose-high-denial-rates
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CQC @4qualitycare.bsky.social · 26/08/2026
Cook County, IL, just erased >$1B in medical debt, and while that’s a welcome move, we should ask ourselves why it is necessary. What is driving the rapid increase in medical debt that’s forcing local governments to spend taxpayer dollars to forgive? www.beckershospitalreview.com/finance/illi...
beckershospitalreview.com
https://www.beckershospitalreview.com/finance/illinois-county-surpasses-1b-in-medical-debt-relief/
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CQC @4qualitycare.bsky.social · 22/08/2026
Cuts to federal healthcare funding leave behind the patients who need care the most. In Michigan alone, over 90,000 people have lost Medicaid coverage and 130,000 dropped ACA coverage. This is not accessible healthcare; this is an affordability crisis. www.michiganpublic.org/health/2026-...
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CQC @4qualitycare.bsky.social · 21/08/2026
Facility fees create an environment where prices change according to where you received care, not what kind of care you received. Good thing Vermont is cracking down on this. More states should follow their example. www.wcax.com/2026/08/17/v...
wcax.com
Vermont moves to rein in hospital ‘facility fees’
So-called hospital facility fees, which can add hundreds of dollars to bills after routine doctor visits at hospital-owned clinics.
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CQC @4qualitycare.bsky.social · 20/08/2026
Prior authorization delays access to care, not by accident but by design. There’s nothing wrong with using tech to make prior authorization incrementally less harmful, but it shouldn’t distract us from the goal, which is to eliminate prior auth entirely. www.techtarget.com/revcyclemana...
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CQC @4qualitycare.bsky.social · 19/08/2026
The US has one of the highest maternal mortality rates among high-income countries, with stark racial disparities. The Momnibus Act, just reintroduced in the Senate, will address the drivers of the Black maternal health crisis. It’s time to protect mothers and perinatal workers.
baldwin.senate.gov
Baldwin Introduces Comprehensive Bill to Combat Maternal Health Crisis, Support Mothers and Babies | U.S. Senator Tammy Baldwin of Wisconsin
WASHINGTON, D.C. – U.S. Senator Tammy Baldwin (D-WI) joined her colleagues to reintroduce the...
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CQC @4qualitycare.bsky.social · 18/08/2026
We responded to the Senate Committee on Finance’s RFI on prescription drug pricing. Our message to the committee: Prioritize increasing transparency, lowering out-of-pocket costs, and holding health insurance companies accountable for covering our care. consumers4qualitycare.org/press/2026/0...
consumers4qualitycare.org
Consumers for Quality Care Urges Senate Finance Committee to Hold PBMs and Insurers Accountable for Prescription Drug Costs | Consumers for Quality Care
Washington, D.C. — Today, Consumers for Quality Care (CQC) submitted formal comments to the Senate Committee on Finance in response to its Request for
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CQC @4qualitycare.bsky.social · 17/08/2026
Hospital monopolies raise costs and lower quality. In NC, one hospital monopoly charged as much as $24,000 more for knee surgery, compared to other hospitals in the state. On top of this, the same hospital system has struggled with harmful practices and poor care. kffhealthnews.org/health-indus...
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CQC @4qualitycare.bsky.social · 14/08/2026
The price of care shouldn’t change based on where you go to get treated. Congress needs to pass site-neutral legislation and prevent hospitals from buying out local practices and price-gouging patients in need. www.healthcaredive.com/news/congres...
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CQC @4qualitycare.bsky.social · 12/08/2026
Prior authorization paperwork eats the equivalent of 99.5K full-time doctors' worth of time, costing $32.6B/year. Insurers profit by denying pre-approved claims, now increasingly automated with AI. 71% of Americans support banning it. shorturl.at/fZ0B1
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CQC @4qualitycare.bsky.social · 11/08/2026
5 states are leading PBM reform: AR banned PBMs from owning pharmacies, CA capped insulin at $35 w/ rebates to patients, IA boosted transparency, TX banned steering. With 13 more states targeting vertical integration, PBM's stranglehold on drug pricing is facing real opposition. shorturl.at/bWB4Y
amcp.org
5 States Driving PBM Reform in 2026 | AMCP.org
All 50 states have enacted some sort of pharmacy benefit manager (PBM) legislation, but a handful are setting the pace in terms of new laws targeting ownership restrictions, transparency…
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CQC @4qualitycare.bsky.social · 10/08/2026
Arizona erased $1B in medical debt for residents under earning 400% or less of federal poverty level. This is certainly a step in the right direction, but it doesn’t touch the root of the problem: hospitals’ leaving patients with unaffordable medical bills. hoodline.com/2026/08/ariz...
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CQC @4qualitycare.bsky.social · 07/08/2026
After kicking millions off Medicaid and raising the cost of insurance through the ACA, the Trump administration is now promoting junk plans that don’t provide adequate coverage. But thankfully Delaware and 19 other states are suing to stop this bad plan. news.delaware.gov/2026/08/03/a...
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CQC @4qualitycare.bsky.social · 05/08/2026
NC ACA premiums skyrocketed after subsidies expired - some jumped from $285 to $600/mo, others to nearly $3,000. Enrollment fell 21%, among the steepest declines nationwide, as deductibles hit a record $3,786. www.charlotteobserver.com/news/politic...
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CQC @4qualitycare.bsky.social · 04/08/2026
450,000 New Yorkers lost coverage July 1 when subsidies expired. Experts warn it could mean 42,500 deaths/year. Cheapest plan: $200/mo — unaffordable for families earning $31K-$39K. www.amny.com/law/lawyers-...
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CQC @4qualitycare.bsky.social · 03/08/2026
Maine’s response to the medical debt crisis goes into effect this week. LD 2129 prohibits medical debt collectors from garnishing wages or placing liens on patient homes because of a missed payment. Read more from Maine Sen. Denise Taylor: www.pressherald.com/2026/07/27/m...
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CQC @4qualitycare.bsky.social · 01/08/2026
New CMS rules threaten to limit who is eligible to receive Medicaid, making care less accessible for the Americans who need it most. In some cases, a cancer diagnosis isn’t even enough to bypass Federal work requirements. Read more: www.politico.com/news/2026/07...
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CQC @4qualitycare.bsky.social · 31/07/2026
PBMs work at the expense of the patient, not for. PMBs sued CA, opposing a rule that “requires PBMS to act in the best interest of their clients.” Predatory PBMs contribute to the growing medical debt crisis, rising costs across the board for patients in need. news.bloomberglaw.com/employee-ben...
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CQC @4qualitycare.bsky.social · 30/07/2026
When a Dr.’s independent practice gets bought by a hospital, the care stays the same, but the bill doubles. This encourages consolidation and leaves patients paying more for identical services. www.forbes.com/sites/richar...
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CQC @4qualitycare.bsky.social · 30/07/2026
23 Los Angeles hospitals are breaking federal price-transparency rules. They're hiding inflated prices behind opaque billing, facility fees, and confusing estimates. Hospital consolidation crushed competition. mynewsla.com/business/202...
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CQC @4qualitycare.bsky.social · 29/07/2026
Kentucky passed a new law eliminating cost barriers for colon cancer screening. No prior authorization from your insurance company. No deductibles or copays. Early detection saves lives & cuts treatment costs by 90%. Every state should have a law like this.
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CQC @4qualitycare.bsky.social · 29/07/2026
Nearly 1 in 4 workers are now trapped in jobs they hate just to keep health insurance. Five years ago, it was 1 in 6. As healthcare costs skyrocket, more people are sacrificing their careers just to stay insured. This is a fundamentally broken system. www.healthcaredive.com/news/1-in-5-...
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CQC @4qualitycare.bsky.social · 28/07/2026
The No Surprises Act was supposed to protect patients from medical bills. Instead, providers have weaponized the arbitration system to raise prices, collecting nearly $15B in 2025. www.wsj.com/health/healt...
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CQC @4qualitycare.bsky.social · 28/07/2026
For the first time, CMS admitted the No Surprises Act is being "gamed to get higher prices." A law designed to protect patients is being exploited by providers instead.
nytimes.com
Trump Administration Says Surprise Billing Law Is Being ‘Gamed’ by Doctors
For the first time, officials have acknowledged problems with the No Surprises Act, which has led to huge payments.
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CQC @4qualitycare.bsky.social · 27/07/2026
Voluntary promises aren’t enough when a patient’s health is on the line, and prior authorization fails to protect patients. Instead of increasing quality of care, it creates delays and denials that worsen patient treatment and raises costs. mexicoledger.com/premium/stor...
mexicoledger.com
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CQC @4qualitycare.bsky.social · 25/07/2026
Consumers lose when hospitals merge. The end result is almost always higher prices, higher insurance premiums, and lower quality of care. Friendly reminder that hospital consolidation helps no one but the wealthy executives who run these behemoths. www.chiefhealthcareexecutive.com/view/more-ho...
chiefhealthcareexecutive.com
More hospital mergers in first half of 2026, and momentum may continue | Chief Healthcare Executive
The number of deals in the first six months of the year has nearly matched the transactions seen in all of 2025. Analysts expect more mergers and acquisitions in the months ahead.
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CQC @4qualitycare.bsky.social · 24/07/2026
Congress is cracking down on whether tax-exempt hospitals are using those benefits towards the public, or if it’s just another measure to protect revenue. This is a step in the right direction, and it ensures public resources are used to help people. waysandmeans.house.gov/2026/07/20/w...
waysandmeans.house.gov
What They Are Saying: Ways and Means Committee Bringing Transparency to America’s Nonprofit Hospital Sector - Ways and Means
WASHINGTON, D.C. – America’s nonprofit hospitals will be more transparent with patients and taxpayers about the actual charity care they...
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CQC @4qualitycare.bsky.social · 23/07/2026
23 Southern California hospitals – and 500 nationwide – were recently warned for hiding their prices in defiance of federal price-transparency rules. It’s hard to find any community where local hospitals are not keeping patients in the dark about the cost of their care.
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