Ghost Rates and Garbage Data

How Hospitals Are Sabotaging Price Transparency—and What Fiduciaries Must Do About It

Fictional Pricing and the Transparency Shell Game

Four years. That’s how long hospitals have had to follow the federal price transparency rule. Not four weeks, not four months. Four years. And still? A third of them haven’t even bothered to post a single file. Not one spreadsheet. Not one sad little CSV buried on a dark corner of a clunky website. Nothing.

And the ones who do comply? Well—if dumping a few thousand rows of fictional price data onto a barely functional site counts as “compliance,” then sure. They’re nailing it.

Let’s be honest. This isn’t confusion. It’s subterfuge. Hospitals know exactly what they’re doing. The rule said “transparency.” They heard “bury it in garbage.” And that’s exactly what they’ve done—on purpose.

In 2022, only 16% of hospitals were in full compliance with the federal mandate. That number has crept up, but not by much. More than 30% of hospitals still haven’t posted anything at all. And among those that have, a majority are posting nonsense: contradictory, outdated, or flat-out fabricated price files.

KFF Health News recently reported a stunner: in New York City, insurers are listing reimbursements paid to optometrists for GI scopes, audiologists for cardiac procedures, and dentists for orthopedic surgeries. These aren’t typos. They’re “ghost” or “zombie” rates—fictional payments for impossible scenarios, sprinkled into the data like static to jam the signal.

And yes, these files originate with the hospitals. The data doesn’t just get weird on its own. So, is this rampant incompetence or blatant disregard of the law? I suspect it’s a tasty little helping of both.

Even when hospitals aren’t performing your colonoscopy with the local eye doctor, they’re posting three different prices for the exact same service, at the exact same hospital, for the exact same payer. UnitedHealthcare, for instance, lists $47,000, $64,000, and $70,000 for the same heart attack treatment at New York-Presbyterian/Weill Cornell. Meanwhile, Aetna decided everything from respiratory infections to digestive tract cancers should cost—very precisely—$6,292. Every time. For everything.

That’s not transparency. It’s blatant disregard, concealment, or both.

To the Compliant: Keep Going. It’s Working.

Now, credit where it’s due.

There are hospitals taking this seriously. They’ve published clean, machine-readable files that accurately reflect negotiated rates. They’re posting them in accessible formats, not behind broken links or 5-click menus. And they’re doing so in a way that allows benefit advisors like us to guide employer plans toward smarter, more transparent design.

To those hospitals—truly: hats off.

Your work is making a difference. It's giving us tools we’ve never had before to compare prices, guide patients, and protect plans from egregious, unjustified charges. The progress you're enabling is real—and we’re putting it to use.

But unfortunately, you remain in the minority. And the prevailing strategy among the majority is still delay, distract, dump, and deny.

Don’t Build Your Plan on Fiction—Use a Benchmark That Holds Up

And here’s the dangerous part: even with all of this dysfunction laid bare, some fiduciaries are being told that cash prices or hospital-posted rates are “good enough” to build a plan around.

They’re not. Not even close.

If you’re relying on transparency data as it exists today to set reimbursements, you're walking a fiduciary tightrope in a storm—blindfolded. These numbers aren’t reliable. They’re not verified. And in many cases, they’re flat-out invented.

What you need is a real benchmark. One built on decades of cost data. One that’s been audited, litigated, and refined. That benchmark is Medicare.

No, I’m not saying 100% of Medicare is always sufficient. But 125% to 200%? That better be reasonable. If a hospital can’t survive on 200% of Medicare, the issue isn’t your reimbursement mechanism—it’s their operating model. Their administrative overhead. Their capital buildout. Their lack of efficiency. That’s not your plan’s problem to solve.

Medicare is measurable. Consistent. Defensible. When the time comes—and it will—for a regulator, plaintiff’s attorney, or auditor to ask how your plan determined “reasonable and appropriate payment,” you need more than a spreadsheet that says an eye doctor billed for a liver transplant.

Until federal enforcement grows a backbone and starts treating fake transparency like the fraud it is, hospitals will keep playing this game. But fiduciaries can’t. You don’t get the same out. You don’t get to point at chaos and shrug. Guess you should be paying lobbyists to buy more stringent protection for your locally rented politician.

You have a duty. And that duty starts with calling fiction what it is—and building your plan on facts.

Because if a dentist’s billing for your coronary bypass and it’s buried in a 4,000-line Excel sheet somewhere on a hospital website, it’s not just bad data. It’s a sinisterly manipulated system. And unless you’re benchmarking against something real, like Medicare, you’re on the hook for it.