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our rules, means we don t do the procedure. which would mean if they provide these procedures they should be telling us how much it costs. reporter: in the two years since the law took effect, cms has only issued two fines, given as nbc was pressing the hhs secretary last summer. the buck stops with you you re the secretary. brooks-lasure says they have given 500 warning letters to hospitals, and now the maximum fines have been increased from $100,000 to $2 million so we asked what s the biggest holdup cms blames the pandemic. they haven t always had all of the staff to really focus on some of the i.t. system changes that need to happen. reporter: the american hospital association, which represents health care networks and hospitals, says health systems remain, quote, deepl committed despite considerable strains on the hospital workforce over the past three years. who hurts the most? it s the american people. reporter: in washington, marissa parra, nbc news.

It costsCenters for medicare and medicaid servicesNbc newsWarning lettersHhs secretary last summerBrooks lasureThe american hospital associationI tThey haven t2 millionHealth systemsMarissa parraHospital workforceHealth care networks