Office of Appeals and Hearings
Notice of Penalty
If you have received a Notice of Penalty, 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”) or 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 of Penalty along with a copy of the Notice to:
HCAI/ASD/Accounting
2020 West El Camino Avenue, Suite 1000
Sacramento, CA 95833
Request for Administrative Hearing
If you choose to appeal this penalty, you must request an Administrative Hearing. If you are You must request an administrative hearing within 15 business days of receipt of the Notice of Penalty (Health Data and Advisory Council Consolidation Act or “Data Act”) or 30 calendar days of the date of the Notice (Prescription Drug Pricing for Purchasers or “CTRx”). 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
- Prescription Drug Pricing for Purchasers Request for Administrative Hearing
You may submit the Request for Administrative Hearing electronically to HearingOfficer@hcai.ca.gov and your program contact or mail your request to:
HCAI Legal Office
ATTN: Office of Appeals and Hearings
2020 West El Camino Avenue, Suite 1217
Sacramento, CA 95833
Please review the Data Act Hearing Procedures or Prescription Drug Pricing for Purchasers Hearing Procedures prior to submitting your appeal.
Request for Consolidation of Appeals
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. The consolidation request may be submitted electronically to HearingOfficer@hcai.ca.gov and your program contact or you may mail your request to:
HCAI Legal Office
ATTN: Office of Appeals and Hearings
2020 West El Camino Avenue, Suite 1217
Sacramento, CA 95833
If you have any questions, please reach out to the contact listed in your Notice of Penalty letter or the Hearing Office at (916) 326-3610 or HearingOfficer@hcai.ca.gov.
Historical Decisions
Database of Director’s Decisions for both Prescription Drug Pricing for Purchasers (“CTRx”) and Health Data and Advisory Council Consolidation Act (“Data Act”). 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 Name | Report Type | Appeal Status | Director's Decision |
|---|---|---|---|---|
| 22-018-LTC | Archwood House | LTC Annual Financial | Penalty Waived | |
| 22-016-LTC | Milpitas Care Center | LTC Annual Financial | Penalty Upheld | |
| 22-015-LTC | Montrose Comfort Living & Care | LTC Annual Financial | Penalty Upheld | |
| 22-014-LTC | Madrone House | LTC Annual Financial | Penalty Waived | |
| 22-013C-LTC | Parkside Congregate Living, Inc. | LTC Annual Financial | Penalty Waived | |
| 22-012-LTC | Grand Villa CLHF | LTC Annual Financial | Penalty Upheld | |
| 22-011-LTC | Chino Avenue Congregate Home | LTC Annual Financial | Penalty Upheld | |
| 22-010-LTC | Milpitas Care Center | LTC Annual Financial | Penalty Reduced | |
| 22-009-LTC | Meadowood Nursing Center | LTC Annual Financial | Penalty Upheld | |
| 22-005-HQF | Watsonville Community Hospital | Quarterly Financial and Utilization | Penalty Upheld | |
| 22-003-LTC | George Mark Children's House | LTC Annual Financial | Penalty Waived | |
| 21-046-LTC | Westwood Post Acute | LTC Annual Financial | Penalty Waived | |
| 21-045-LTC | Vista Del Sol Care Center | LTC Annual Financial | Penalty Upheld | |
| 21-044-LTC | Santa Paula Post Acute Center | LTC Annual Financial | Penalty Upheld | |
| 21-043-LTC | Reutlinger Community | LTC Annual Financial | Penalty Upheld | |
| 21-042-LTC | Miracle Mile HC Center | LTC Annual Financial | Penalty Reduced | |
| 21-041-LTC | Gladstone Care and Rehab Center | LTC Annual Financial | Penalty Waived | |
| 21-040-LTC | Brookdale Carmel Valley | LTC Annual Financial | Penalty Upheld | |
| 21-039-HQF | Motion Picture and TV Fund Hospital | Quarterly Financial and Utilization | Penalty Waived | |
| 21-038-LTC | The Royal Home | LTC Annual Financial | Penalty Waived | |
| 21-037C-LTC | Dycora Transitional Health Facilities | LTC Annual Financial | Penalty Upheld | |
| 21-036C-LTC | Windsor Facilities | LTC Annual Financial | Penalty Waived | |
| 21-034-LTC | Blossom Ridge LTC Facility | LTC Annual Financial | Penalty Waived | |
| 21-032-LTC | Valmont Care Center | LTC Annual Financial | Penalty Waived | |
| 21-031C-LTC | Corbin Congregate Home | LTC Annual Financial | Penalty Waived | |
| 21-030-Q1 | VistaPharm, Inc. | Quarterly WAC Increase | Penalty Upheld | |
| 21-029-HQF | Marshall Medical Center | Quarterly Financial and Utilization | Penalty Waived | |
| 21-028-LTC | Pierce Congregate Living | LTC Annual Financial | Penalty Upheld | |
| 21-027-LTC | MSB, Inc. Congregate Living | LTC Annual Financial | Penalty Upheld | |
| 21-026-LTC | Bay Point Health Center | LTC Annual Financial | Penalty Upheld | |
| 21-025-LTC | Pulse Health Facility | LTC Annual Financial | Penalty Upheld | |
| 21-024-LTC | Burbank Congregate Living Center | LTC Annual Financial | Penalty Waived | |
| 21-020C-HQF | Plumas District Hospital | Quarterly Financial and Utilization | Penalty Waived | |
| 21-013-HAF | Sonoma Specialty Hospital | Hospital Annual Financial | Penalty Reduced | |
| 21-008-Q2 | Secura Bio, Inc. | Quarterly WAC Increase | Penalty Upheld | |
| 21-007-HQF | Stabler Lane Behavioral Health | Quarterly Financial and Utilization | Penalty Waived | |
| 21-006-HQF | Centinela Hospital Medical Center | Quarterly Financial and Utilization | Penalty Upheld | |
| 21-004-HAF | Colusa Medical Center | Hospital Annual Financial | Penalty Waived | |
| 21-003-LTC | The Royal Home | LTC Annual Financial | Penalty Waived | |
| 21-001-HQF | Kindred Hospital San Diego | Quarterly Financial and Utilization | Penalty Reduced | |
| 20-040C-LTC | United Care Basque | LTC Annual Financial | Penalty Upheld | |
| 20-039-Q1 | Acella Pharmaceuticals, LLC | Quarterly WAC Increase | Penalty Reduced | |
| 20-037C-LTC | Corbin Congregate Home | LTC Annual Financial | Penalty Waived | |
| 20-031C-HQF | Northern Inyo Healthcare District | Quarterly Financial and Utilization | Penalty Waived | |
| 20-029-Q39 | Novartis | Quarterly WAC Increase | Penalty Waived | |
| 20-028C-HQF | Kaiser Foundation | Quarterly Financial and Utilization | Penalty Waived | |
| 20-023C-Q16 | Alembic Pharmaceuticals Inc. | Quarterly WAC Increase | Penalty Reduced | |
| 20-021-Q1 | Parsolex GMP Center, Inc | Quarterly WAC Increase | Penalty Reduced | |
| 20-018-Q2 | Boehringer Ingelheim Pharmaceuticals, Inc. | Quarterly WAC Increase | Penalty Waived | |
| 20-015-Q2 | AvKare | Quarterly WAC Increase | Penalty Waived | |
| 20-014-Q4 | Sun Pharmaceutical Industries, Inc. | Quarterly WAC Increase | Penalty Reduced | |
| 20-010-Q11 | Supernus Pharmaceuticals, Inc. | Quarterly WAC Increase | Penalty Upheld | |
| 20-007-HAF | Pomerado Hospital | Hospital Annual Financial | Penalty Waived | |
| 20-006-LTC | Lavista Congregate Living Health Facility | LTC Annual Financial | Penalty Waived | |
| 20-001-LTC | Hillside House | LTC Annual Financial | Penalty Waived | |
| 19-021-HQF | Community Regional Medical Center | Quarterly Financial and Utilization | Penalty Upheld | |
| 19-020-LTC | Mercy Retirement & Care Center | LTC Annual Financial | Penalty Upheld | |
| 19-019-LTC | Astor Healthcare Center | LTC Annual Financial | Penalty Waived | |
| 19-018-HQF | Rose Desert Congregate Care | Quarterly Financial and Utilization | Penalty Reduced | |
| 19-017-LTC | Paradise Congregate Living | LTC Annual Financial | Penalty Waived | |
| 19-013-HQF | Cirby Hills Behavioral Health | Quarterly Financial and Utilization | Penalty Waived | |
| 19-012-LTC | Pacific Haven Subacute and Healthcare Center | LTC Annual Financial | Penalty Waived | |
| 19-008-LTC | San Fernando Post Acute Hospital | LTC Annual Financial | Penalty Waived | |
| 19-004C-LTC | White Oak CLF, Senior Congregate Living | LTC Annual Financial | Penalty Waived | |
| 19-002-HQF | Antelope Valley Hospital | Quarterly Financial and Utilization | Penalty Reduced | |
| 19-001-LTC | Camelia Gardens Care Center | LTC Annual Financial | Penalty Waived | |
| 18-013-HQF | Loma Linda Univ. Medical Center - Murrieta | Quarterly Financial and Utilization | Penalty Waived | |
| 18-012C-LTC-3 | New Orange Hills | LTC Annual Financial | Penalty Waived | |
| 18-012C-LTC-2 | North Starr Postacute Care, Main West Postacute Care | LTC Annual Financial | Penalty Upheld | |
| 18-012C-LTC-1 | Indio Nursing & Rehab Center, Legacy Post-Acute Rehab Center | LTC Annual Financial | Penalty Upheld | |
| 18-011-LTC | Hospice of San Joaquin | LTC Annual Financial | Penalty Waived | |
| 18-008-LTC | Park Merritt Care Center | LTC Annual Financial | Penalty Upheld | |
| 18-006C-HAF | Barstow Community Hospital | Hospital Annual Financial | Penalty Upheld | |
| 18-005-LTC | New Orange Hills | LTC Annual Financial | Penalty Waived | |
| 18-004C-LTC | St. Rita's Haven | LTC Annual Financial | Penalty Waived | |
| 18-003C-LTC | Heartwood Avenue Healthcare | LTC Annual Financial | Penalty Upheld | |
| 18-002-LTC | Garden Crest Convalescent Hospital | LTC Annual Financial | Penalty Waived | |
| 18-001C-LTC | United Care Pelona, United Care Minford, United Care Basque | LTC Annual Financial | Penalty Waived |