Where the Compliance Map Turned Red
Issue 003 • Week of April 20, 2026 • Regional compliance, state-by-state
The story we published six weeks ago — "the compliance gap is in rural and independent Texas hospitals" — was true when we wrote it and is false today. Texas rural hospitals now run at 93.3% verified compliance, ahead of Texas mid-sized metros (84.1%) and even with major metros (91.7%). The gap didn't close state-by-state evenly. It moved to Florida. 501 of 740 tracked Florida hospitals (67.7%) still do not publish a verifiable MRF. Sixteen FL regional health systems have a 0% compliance rate. The map is red where it wasn't before.
State-level compliance map — April 2026
| State | Active hospitals tracked | Verified publishers | % verified | State of play |
|---|
| Texas | 573 | 519 | 90.6% | Compliance is effectively universal outside ~54 outlier facilities. |
| Florida | 740 | 239 | 32.3% | Where Texas was in Q4 2025. The new front. |
| New York | 198 | 98 | 49.5% | Academic majors compliant; Independents + SUNY campuses lag. |
| Illinois (partial coverage) | 7 | 7 | 100% | Limited seed coverage; expansion targeted. |
| North Carolina (partial) | 6 | 6 | 100% | Limited seed coverage. |
| Ohio (partial) | 6 | 6 | 100% | Limited seed coverage. |
| Pennsylvania (partial) | 4 | 4 | 100% | Limited seed coverage. |
| California (partial) | 3 | 3 | 100% | Limited seed coverage; Kaiser-gated networks excluded. |
"Verified publisher" = hospital has at least one SHA-256-hashed MRF file successfully downloaded from their endpoint within the last 7 days. States marked partial are undergoing seeding expansion this month; small-n 100% results are not representative.
Texas — the compliance map closed by region
Six weeks ago we identified South Texas / RGV, West Texas / Panhandle, and El Paso as the non-compliant pockets. After systematic URL corrections across corporate parent CDNs, document-management subfolders, and aggregator feeds, the regional picture across Texas now looks nearly uniform:
| Region tier | Active hospitals | Verified publishers | % verified |
|---|
| Rural & small-market TX (cities with 1 hospital) | 193 | 180 | 93.3% |
| Major-metro TX (cities with 5+ hospitals: Houston, Dallas, Austin, SA, Fort Worth) | 254 | 233 | 91.7% |
| Mid-market TX (cities with 2-4 hospitals) | 126 | 106 | 84.1% |
The remaining 54 non-publishing TX hospitals are scattered across mid-market cities without the concentrated regional patterns we saw six weeks ago. There is no longer a "Panhandle problem" or a "Valley problem" — there is a small uneven tail.
Florida — the regional map today
Florida's 740 tracked hospitals show concentration of non-compliance in specific regional systems and the Independent tier. Numbers below are verified within the last 7 days.
| FL health system / grouping | Hospitals | Verified | % verified |
|---|
| Baptist Health System (FL) | 24 | 20 | 83.3% |
| HCA Healthcare (FL) | 55 | 44 | 80.0% |
| AdventHealth | 30 | 24 | 80.0% |
| Ascension (FL) | 13 | 9 | 69.2% |
| Orlando Health | 13 | 8 | 61.5% |
| Cleveland Clinic (FL) | 8 | 3 | 37.5% |
| Mount Sinai Health System (FL) | 4 | 1 | 25.0% |
| Tampa General | 6 | 1 | 16.7% |
| Baptist Health (FL multistate) | 9 | 1 | 11.1% |
| Jackson Health (FL) | 3 | 0 | 0% |
| Steward Health (FL) | 7 | 0 | 0% |
| Community Health Systems (FL) | 2 | 0 | 0% |
| Independent / Other (FL) | 563 | 127 | 22.6% |
If Texas's template for compliance closure repeats here, Florida's major systems (HCA, AdventHealth, Baptist FL) will likely close the gap in 3-6 months. The independent tier — 563 hospitals, 436 non-publishers — is a multi-year front unless aggressive attention is applied.
Three findings that matter
- The "Texas rural" thesis is retired. Rural TX hospitals are now more compliant than mid-market TX hospitals. Last quarter's "Rio Grande Valley 7.7%" and "El Paso 15.4%" findings are no longer accurate — those regions caught up fast. Any compliance or transparency strategy built on those numbers needs to be revised.
- Steward Health, Jackson Health, and Community Health Systems (in Florida) publish zero verifiable files. 12 hospitals across three systems, zero publishers. These are the cleanest enforcement-gap targets in our entire dataset.
- The Independent tier in Florida is where the next two years of work lives. 563 independent FL hospitals, 436 non-publishers. That is bigger than the entire Texas independent tier ever was. The hidden-URL pattern that applied to Texas academic centers almost certainly applies here too — many of the 436 probably DO publish, just not at their registered URLs. Deep-crawl discovery is the unlock.
Why this matters — by role
For health plan network analysts with Florida exposure.
Your FL network is negotiating with systems where most facilities' rates are not verifiable. Until we close the discovery gap in Florida (our near-term roadmap), your in-network leverage in the state is structurally capped below what you can achieve in Texas. We can produce a facility-by-facility pull of the 239 verified FL publishers for immediate benchmarking.
For benefits brokers selling into Florida self-funded employers.
The same rate-transparency report you can deliver in Texas (based on 519 verified publishers) is structurally harder in Florida. For named employer engagements where rate data matters, carrier-specific analysis on the verified FL subset plus targeted deep-crawl of the Independent tier around the employer's facility network is our standard broker-client pack.
For healthcare consultancies with a Southeast practice.
The 563 independent FL hospitals with paper-only or unknown status are your prospect list. Same engagement model that worked for Texas independents applies: one-shot audit + remediation plan + optional ongoing monitoring. Pricing adjusts by facility count; turnkey for systems of 3-25 facilities.
For plaintiff's attorneys.
Steward Health (7 FL facilities, 0 publishing), Jackson Health (3 / 0), Community Health Systems (2 / 0), Tampa General (1 of 6) represent the cleanest enforcement-gap evidence with SHA-256-stamped crawler logs. Deposition-grade exhibits available on request.
For rural-health advocacy / state policy offices.
The rural-Texas compliance narrative is effectively resolved. The Florida independent-hospital narrative is open. Policy pressure would have significantly more leverage in Florida today than anywhere in Texas.
What we offer
Florida System-Compliance Audit — $18,000: Full audit of a named FL health system (up to 25 facilities), SHA-256 archive, remediation brief identifying the corporate-CDN / document-subfolder pattern (if any), enforcement-risk ranking. 2-week turnaround.
Broker Client Report (Florida employer) — from $25,000: Per-facility verified-publisher status across the FL metros where the employer has members, rate benchmarking for shoppable procedures, and steering-savings projection on the employer's claim volume. 7–14 day turnaround.
Regional Deep-Crawl Pack (multi-state) — $75,000: 90-day campaign of targeted deep-crawl discovery across up to 500 named independent hospitals in a chosen state or metro, weekly URL-corrections feed, full SHA-256 archive of discovered real MRFs. Designed for aggregators, journalists, and large consultancies.
Reply to discuss an engagement or to receive next week's brief.
Next issue
Week of April 27: the payer market — which carriers actually dominate our 6.2B-row fact table, how canonical payer normalization changes the story, and why "Blue Cross Blue Shield" appears 18 different ways in raw MRF files.