California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 9.2 - Hospital Fair Billing Program › Article 5 - Administrative Penalties › Section 96051.26 - Adjustments to the Base Penalty

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  base penalty determined in section
				  96051.25 shall be adjusted
				  considering each of the following factors:
(1)
				  Nature, Scope, and Severity. The initial penalty shall be adjusted upward by 20
				  percent if the hospital's policies, postings, or screening practices are not in
				  compliance with Health and Safety Code sections
				  127405
				  through
				  127435,
				  inclusive.
(2) Compliance history
				  with related state and federal laws. A hospital's compliance history refers to
				  its record of compliance with the Act and this chapter, and with related
				  federal laws. Violations of the Act prior to January 1, 2022, and violations of
				  this chapter prior to January 1, 2024, will not be considered.
(A) The base penalty shall be adjusted
				  downward by five percent if there are no violations of related state or federal
				  laws within the three-year period immediately prior to the date of the
				  violation.
(B) The base penalty
				  shall be increased by five percent if there are any violations of related state
				  or federal laws within the three-year period immediately prior to the date of
				  the violation.
(C) The base penalty
				  shall be increased 50 percent if all the following conditions are met:
(i) The hospital has been assessed a penalty
				  for prior violations of the Act or this chapter, within the three-year period
				  immediately prior to the date of the violation.
(ii) The previous violation is similar in
				  nature to the current violation.
(iii) The incident for which the current
				  penalty is being assessed occurred after the hospital was notified of the
				  Department's penalty determination for the prior violation used to enhance the
				  penalty.
(3)
				  Willful violation. The initial penalty shall be adjusted upward by 20 percent
				  if the deficiency was the result of a willful violation.
(A) "Willfulness," "willfully," or "willful"
				  mean that the person doing an act or omitting to do an act intends the act or
				  omission, and knows the relevant circumstances connected with the act or
				  omission.
(4) Factors
				  beyond the hospital's control. For factors beyond the hospital's control that
				  restrict the hospital's ability to comply with the requirements of the Act, the
				  initial penalty shall be adjusted downward by 20 percent.
(5) Immediate correction of the violation.
				  When the Department determines that a hospital subject to an administrative
				  penalty promptly corrects the noncompliance for which the administrative
				  penalty was imposed, the base penalty shall be adjusted downward by 20 percent,
				  provided all the following apply:
(A) The
				  hospital identified and immediately corrected the noncompliance before the
				  noncompliance was identified by the Department.
(B) The hospital initiated corrective action
				  and took appropriate steps to prevent the violation from recurring, with prompt
				  and detailed documentation of the action.
(C) The hospital did not receive a penalty
				  reduction under this subsection within the 12-month period prior to the
				  violation.