OCA board adopts phased penalties for late data submissions, with public urging for tougher fines

The Office of Health Care Affordability board voted to adopt a phased enforcement process for late or incomplete data submissions on health plan and provider reporting, approving a structure staff designed in response to board and stakeholder feedback.

Under the adopted framework, data submitters face an initial flat ‘‘untimely’’ penalty if they miss the September 1 filing deadline and any optional extensions. Staff outlined a progressive structure: a $10,000 untimely penalty followed by a $50,000 untimely penalty if missed windows persist; a per‑member failure‑to‑submit penalty that starts at $5 per member on Dec. 1 and rises to $10 per member by Dec. 31, with those per‑member amounts doubling in subsequent years if noncompliance continues. OCA also described procedural steps that would begin as early as November 1 (notice, required submission plan, technical assistance), with options for a public meeting and administrative enforcement through an administrative law judge or court action.

Deputy Director Begani said the changes accelerate enforcement timing from prior drafts and add an earlier progressive‑enforcement step in November to encourage timely compliance.

Public commenters — including Health Access, the California Pan‑Ethnic Health Network and labor organizations — strongly urged larger penalties tied to an entity’s size or national revenue. Beth Kappell of Health Access said a per‑member $5 or $10 penalty would be insufficient against large insurers and said missing or incomplete data can translate into billions in costs if left unaddressed.

Some board members expressed skepticism that the initial per‑member amounts alone would deter large nondomestic insurers, but several members said staff should rely on the combination of tools available (penalties, administrative action, referrals to licensing/regulatory agencies) and revisit levels if future compliance problems arise. One board member abstained during the subcommittee appointment vote earlier; the penalty framework vote carried with the recorded votes provided by roll call.

OCA staff committed to annual public reporting on data submission compliance and to continuing engagement with submitters to reduce administrative burden. The office also said it will make all assessed penalties public once they are formally imposed.

The board’s action sets an enforcement timeline intended to encourage timely, complete submissions but leaves open future adjustments to ensure penalties scale with submitter size and avoided incentives.