Financial Penalties
Pursuant to Oregon Revised Statute 442.386, OHA may impose a financial penalty on a payer or provider organization when the cost growth exceeded the target with statistical confidence, and without reasonable cause, or is not indeterminate, in a market for at least three out of five calendar years. OHA must not impose financial penalties before January 1, 2026, and the cost growth from 2021 to 2022 must serve as the first year of a payer or provider organization’s first five-year period.
The table below tracks payers and provider organizations that have exceeded the target with statistical confidence and without reasonable cause since the 2021-2022 measurement period.
Payer
| Market
|
2021-2022
|
2022-2023
|
|---|
Moda
| Medicare Advantage
| X
| X
|
UHC Company
| Medicare Advantage
| X
| X
|
PacificSource
| Commercial
| -
| X
|
|
| | |
Provider organization
| Market
|
2021-2022
|
2022-2023
|
|---|
Oregon Medical Group
| Commercial
| X
| -
|
St. Charles Health System
| Commercial
| -
| X
|
The Corvallis Clinic
| Commercial
| -
| X
|
|
| |
|