OCA proposes layered penalties for late or missing health data; board pushes for stronger escalation

The Office of Cost and Accountability (OCA) presented a proposed enforcement framework for payer data submissions that combines per-member penalties for failures to submit, flat untimely fines for late files, and progressive increases for repeat noncompliance. Staff described a two-part untimely penalty, a separate per-member failure-to-submit charge and the option to pursue administrative orders if entities do not comply.

Key components presented by staff: Assistant Deputy Director CJ Howard said the office's proposal includes an initial untimely data-submission penalty of $10,000 and an additional $10,000 if data are still not submitted by Nov. 1; a failure-to-submit penalty tied to membership of $5 per member in the first year that would double in each subsequent noncompliant year; and a five-day correction window for submitters after OCA identifies technical deficiencies. CJ Howard said the $5-per-member penalty "on average ... equates to approximately 0.07% of the plan's annual revenue" and that the per-member figure…