Office of Appeals and Hearings

Health Data and Advisory Council Consolidation Act (“Data Act”) Penalties

If you have received a Notice of Penalty (“Notice”), you must either pay it or request an Administrative Hearing within 15 business days of receipt of the Notice (Health Data and Advisory Council Consolidation Act or “Data Act”). Payment should be made by sending a check in the amount indicated on your Notice along with a copy of the Notice to:

HCAI/ASD/Accounting
2020 West El Camino Avenue, Suite 1000
Sacramento, CA 95833

If you choose to appeal the Notice of Penalty, you must request an Administrative Hearing within 15 business days of receipt of the Notice. You may use the Request for Administrative Hearing form enclosed with your Notice of Penalty or download the form here: Data Act Request for Administrative Hearing

Please review the Data Act Hearing Procedures prior to submitting your appeal.

If you are appealing two or more penalties and wish to request consolidation of the proceedings because the facts, circumstances, and issues are similar, you may submit a Request for Consolidation of Appeals Proceedings form.

Prescription Drug Pricing for Purchasers (“CTRx”) Penalties

If you have received a Notice of Penalty (“Notice”), you must either pay it or request an Administrative Hearing within 30 calendar days of the date of the Notice (Prescription Drug Pricing for Purchasers or “CTRx”). Payment should be made by sending a check in the amount indicated on your Notice along with a copy of the Notice to:

HCAI/ASD/Accounting
2020 West El Camino Avenue, Suite 1000
Sacramento, CA 95833

If you choose to appeal the Notice of Penalty, you must request an Administrative Hearing within 30 calendar days of the date of the Notice. You may use the Request for Administrative Hearing form enclosed with your Notice of Penalty or download the form here: Prescription Drug Pricing for Purchasers Request for Administrative Hearing

    Please review the Prescription Drug Pricing for Purchasers Hearing Procedures prior to submitting your appeal.

    If you are appealing two or more penalties and wish to request consolidation of the proceedings because the facts, circumstances, and issues are similar, you may submit a Request for Consolidation of Appeals Proceedings form.

    Hospital Fair Billing Program Penalties

    If you have received a Notice of Penalty (“Notice”), you must either pay it or request an Administrative Hearing within 30 calendar days of the date of the Notice. Payment should be made by sending a check in the amount indicated on your Notice along with a copy of the Notice to:

    HCAI/ASD/Accounting
    2020 West El Camino Avenue, Suite 1000
    Sacramento, CA 95833

    If you choose to appeal the Notice of Penalty, you must request an Administrative Hearing within 30 calendar days of the date of the Notice. You may use the Request for Administrative Hearing form enclosed with your Notice or download the form here:

    Please review the Hearing Procedures prior to submitting your appeal. No later than five calendar days after filing the request for hearing, you must provide a copy of this Request for Administrative Hearing to the Hospital Fair Billing Program by email at HFBP@hcai.ca.gov.

    If you are appealing two or more penalties and wish to request consolidation of the proceedings because the facts, circumstances, and issues are similar, you may submit a Request for Consolidation of Appeals Proceedings form.

    Contact Information

    If you have any questions, please reach out to the contact listed in your Notice of Penalty or the Office of Appeals and Hearings. Submit appeal documents via e-mail (preferred) or regular mail at:

    HCAI Office of Appeals and Hearings

    2020 West El Camino Avenue, Suite 1217
    Sacramento, CA 95833

    Phone: 9163263610

    Email: HearingOfficer@hcai.ca.gov

    Upcoming Hearings

    All hearings are held at HCAI’s Sacramento office and over Microsoft Teams. Contact HearingOfficer@hcai.ca.gov for dial in information.

    Appeal NumberAppellantScheduled Hearing (Pacific Time)ProgramReport Type
    24-025C-LTCArbor Rehabilitation and Nursing Center11/21/2024 13:30(1) Data Act(1) LTC Annual Financial
    24-024-LTCJuniper Manor LLC11/25/2024 13:30(1) Data Act(1) LTC Annual Financial
    24-026-HQFBear Valley Community Hospital12/4/2024 13:30(1) Data Act(1) Quarterly Financial and Utilization
    24-022-Q1Kite Pharma, Inc.12/11/2024 13:30(2) CTRx(2) Quarterly WAC Increase
    24-005-Q2Laboratoire HRA Pharma12/18/2024 10:30(2) CTRx(2) Quarterly WAC Increase

    Historical Decisions

    Database of Director’s Decisions for Administrative Hearings. Decisions will only be uploaded after the Appellant has been served and the decision has become final. Please note these decisions are not precedential and are for informational use only.

    Appeal No.Appellant NameReport TypeAppeal StatusDirector's Decision
    24-023-LTCSunshine Lovely Inc.LTC Annual FinancialPenalty UpheldPDF
    24-018C-HQFCirby Hills Behavioral Health et alQuarterly Financial and UtilizationPenalty WaivedPDF
    24-007-HQFRehabilitation Hospital of Southern CaliforniaQuarterly Financial and UtilizationPenalty WaivedPDF
    24-006-EDDMayers Memorial Hospital DistrictEmergency Department DataPenalty ReducedPDF
    23-015-LTCMilpitas Care CenterLTC Annual FinancialPenalty ReducedPDF
    23-014C-SDRHoag Memorial HospitalSupplier Diversity ReportPenalty UpheldPDF
    23-013-HQFHighland HospitalQuarterly Financial and UtilizationPenalty UpheldPDF
    23-012-LTCBridge 2 Life - El NidoLTC Annual FinancialPenalty ReducedPDF
    23-010-LTCHilton ManorLTC Annual FinancialPenalty ReducedPDF
    23-009-HQFPalomar Rehabilitation InstituteQuarterly Financial and UtilizationPenalty UpheldPDF
    23-005-HQFKindred Hospital - San Francisco Bay AreaQuarterly Financial and UtilizationPenalty WaivedPDF
    23-003-HAFEncompass Health Rehabilitation Hospital of TustinHospital Annual FinancialPenalty WaivedPDF
    23-002-LTCBlossom Ridge Long Term Care FacilityLTC Annual FinancialPenalty UpheldPDF
    23-001-HQFSouthern Inyo HospitalQuarterly Financial and UtilizationPenalty ReducedPDF
    22-018-LTCArchwood HouseLTC Annual FinancialPenalty WaivedPDF
    22-016-LTCMilpitas Care CenterLTC Annual FinancialPenalty UpheldPDF
    22-015-LTCMontrose Comfort Living & CareLTC Annual FinancialPenalty UpheldPDF
    22-014-LTCMadrone HouseLTC Annual FinancialPenalty WaivedPDF
    22-013C-LTCParkside Congregate Living, Inc.LTC Annual FinancialPenalty WaivedPDF
    22-012-LTCGrand Villa CLHFLTC Annual FinancialPenalty UpheldPDF
    22-011-LTCChino Avenue Congregate HomeLTC Annual FinancialPenalty UpheldPDF
    22-010-LTCMilpitas Care CenterLTC Annual FinancialPenalty ReducedPDF
    22-009-LTCMeadowood Nursing CenterLTC Annual FinancialPenalty UpheldPDF
    22-005-HQFWatsonville Community HospitalQuarterly Financial and UtilizationPenalty UpheldPDF
    22-003-LTCGeorge Mark Children's HouseLTC Annual FinancialPenalty WaivedPDF
    21-046-LTCWestwood Post AcuteLTC Annual FinancialPenalty WaivedPDF
    21-045-LTCVista Del Sol Care CenterLTC Annual FinancialPenalty UpheldPDF
    21-044-LTCSanta Paula Post Acute CenterLTC Annual FinancialPenalty UpheldPDF
    21-043-LTCReutlinger CommunityLTC Annual FinancialPenalty UpheldPDF
    21-042-LTCMiracle Mile HC CenterLTC Annual FinancialPenalty ReducedPDF
    21-041-LTCGladstone Care and Rehab CenterLTC Annual FinancialPenalty WaivedPDF
    21-040-LTCBrookdale Carmel ValleyLTC Annual FinancialPenalty UpheldPDF
    21-039-HQFMotion Picture and TV Fund HospitalQuarterly Financial and UtilizationPenalty WaivedPDF
    21-038-LTCThe Royal HomeLTC Annual FinancialPenalty WaivedPDF
    21-037C-LTCDycora Transitional Health FacilitiesLTC Annual FinancialPenalty UpheldPDF
    21-036C-LTCWindsor FacilitiesLTC Annual FinancialPenalty WaivedPDF
    21-034-LTCBlossom Ridge LTC FacilityLTC Annual FinancialPenalty WaivedPDF
    21-032-LTCValmont Care CenterLTC Annual FinancialPenalty WaivedPDF
    21-031C-LTCCorbin Congregate HomeLTC Annual FinancialPenalty WaivedPDF
    21-030-Q1VistaPharm, Inc.Quarterly WAC IncreasePenalty UpheldPDF
    21-029-HQFMarshall Medical CenterQuarterly Financial and UtilizationPenalty WaivedPDF
    21-028-LTCPierce Congregate LivingLTC Annual FinancialPenalty UpheldPDF
    21-027-LTCMSB, Inc. Congregate LivingLTC Annual FinancialPenalty UpheldPDF
    21-026-LTCBay Point Health CenterLTC Annual FinancialPenalty UpheldPDF
    21-025-LTCPulse Health FacilityLTC Annual FinancialPenalty UpheldPDF
    21-024-LTCBurbank Congregate Living CenterLTC Annual FinancialPenalty WaivedPDF
    21-020C-HQFPlumas District HospitalQuarterly Financial and UtilizationPenalty WaivedPDF
    21-013-HAFSonoma Specialty HospitalHospital Annual FinancialPenalty ReducedPDF
    21-008-Q2Secura Bio, Inc.Quarterly WAC IncreasePenalty UpheldPDF
    21-007-HQFStabler Lane Behavioral HealthQuarterly Financial and UtilizationPenalty WaivedPDF
    21-006-HQFCentinela Hospital Medical CenterQuarterly Financial and UtilizationPenalty UpheldPDF
    21-004-HAFColusa Medical CenterHospital Annual FinancialPenalty WaivedPDF
    21-003-LTCThe Royal HomeLTC Annual FinancialPenalty WaivedPDF
    21-001-HQFKindred Hospital San DiegoQuarterly Financial and UtilizationPenalty ReducedPDF
    20-040C-LTCUnited Care BasqueLTC Annual FinancialPenalty UpheldPDF
    20-039-Q1Acella Pharmaceuticals, LLCQuarterly WAC IncreasePenalty ReducedPDF
    20-037C-LTCCorbin Congregate HomeLTC Annual FinancialPenalty WaivedPDF
    20-031C-HQFNorthern Inyo Healthcare DistrictQuarterly Financial and UtilizationPenalty WaivedPDF
    20-029-Q39NovartisQuarterly WAC IncreasePenalty WaivedPDF
    20-028C-HQFKaiser FoundationQuarterly Financial and UtilizationPenalty WaivedPDF
    20-023C-Q16Alembic Pharmaceuticals Inc.Quarterly WAC IncreasePenalty ReducedPDF
    20-021-Q1Parsolex GMP Center, IncQuarterly WAC IncreasePenalty ReducedPDF
    20-018-Q2Boehringer Ingelheim Pharmaceuticals, Inc.Quarterly WAC IncreasePenalty WaivedPDF
    20-015-Q2AvKareQuarterly WAC IncreasePenalty WaivedPDF
    20-014-Q4Sun Pharmaceutical Industries, Inc.Quarterly WAC IncreasePenalty ReducedPDF
    20-010-Q11Supernus Pharmaceuticals, Inc.Quarterly WAC IncreasePenalty UpheldPDF
    20-007-HAFPomerado HospitalHospital Annual FinancialPenalty WaivedPDF
    20-006-LTCLavista Congregate Living Health FacilityLTC Annual FinancialPenalty WaivedPDF
    20-001-LTCHillside HouseLTC Annual FinancialPenalty WaivedPDF
    19-021-HQFCommunity Regional Medical CenterQuarterly Financial and UtilizationPenalty UpheldPDF
    19-020-LTCMercy Retirement & Care CenterLTC Annual FinancialPenalty UpheldPDF
    19-019-LTCAstor Healthcare CenterLTC Annual FinancialPenalty WaivedPDF
    19-018-HQFRose Desert Congregate CareQuarterly Financial and UtilizationPenalty ReducedPDF
    19-017-LTCParadise Congregate LivingLTC Annual FinancialPenalty WaivedPDF
    19-013-HQFCirby Hills Behavioral HealthQuarterly Financial and UtilizationPenalty WaivedPDF
    19-012-LTCPacific Haven Subacute and Healthcare CenterLTC Annual FinancialPenalty WaivedPDF
    19-008-LTCSan Fernando Post Acute HospitalLTC Annual FinancialPenalty WaivedPDF
    19-004C-LTCWhite Oak CLF, Senior Congregate LivingLTC Annual FinancialPenalty WaivedPDF
    19-002-HQFAntelope Valley HospitalQuarterly Financial and UtilizationPenalty ReducedPDF
    19-001-LTCCamelia Gardens Care CenterLTC Annual FinancialPenalty WaivedPDF
    18-013-HQFLoma Linda Univ. Medical Center - MurrietaQuarterly Financial and UtilizationPenalty WaivedPDF
    18-012C-LTC-3New Orange HillsLTC Annual FinancialPenalty WaivedPDF
    18-012C-LTC-2North Starr Postacute Care, Main West Postacute CareLTC Annual FinancialPenalty UpheldPDF
    18-012C-LTC-1Indio Nursing & Rehab Center, Legacy Post-Acute Rehab CenterLTC Annual FinancialPenalty UpheldPDF
    18-011-LTCHospice of San JoaquinLTC Annual FinancialPenalty WaivedPDF
    18-008-LTCPark Merritt Care CenterLTC Annual FinancialPenalty UpheldPDF
    18-006C-HAFBarstow Community HospitalHospital Annual FinancialPenalty UpheldPDF
    18-005-LTCNew Orange HillsLTC Annual FinancialPenalty WaivedPDF
    18-004C-LTCSt. Rita's HavenLTC Annual FinancialPenalty WaivedPDF
    18-003C-LTCHeartwood Avenue HealthcareLTC Annual FinancialPenalty UpheldPDF
    18-002-LTCGarden Crest Convalescent HospitalLTC Annual FinancialPenalty WaivedPDF
    18-001C-LTCUnited Care Pelona, United Care Minford, United Care BasqueLTC Annual FinancialPenalty WaivedPDF