South Carolina General Assembly
110th Session, 1993-1994

Bill 782


                    Current Status
Introducing Body:               Senate
Bill Number:                    782
Ratification Number:            524
Act Number:                     468
Primary Sponsor:                Rose
Type of Legislation:            GB
Subject:                        Medical assistance provider
                                and recipient fraud
Date Bill Passed both Bodies:   19940602
Computer Document Number:       DKA/4720AL.93
Governor's Action:              S
Date of Governor's Action:      19940714
Introduced Date:                19930518
Date of Last Amendment:         19940601
Last History Body:              ------
Last History Date:              19940714
Last History Type:              Act No. 468
Scope of Legislation:           Statewide
All Sponsors:                   Rose
                                Giese
Type of Legislation:            General Bill

History

Bill   Body    Date          Action Description              CMN  Leg Involved
----   ------  ------------  ------------------------------  ---  ------------
782    ------  19940714      Act No. 468
782    ------  19940714      Signed by Governor
782    ------  19940602      Ratified R 524
782    Senate  19940602      Concurred in House amendment,
                             enrolled for ratification
782    House   19940602      Read third time, returned to
                             Senate with amendment
782    House   19940601      Amended, read second time
782    House   19940524      Committee Report: Favorable     25
                             with amendment
782    House   19940407      Introduced, read first time,    25
                             referred to Committee
782    Senate  19940406      Read third time, sent to House
782    Senate  19940405      Amended, read second time,
                             ordered to third reading with
                             notice of general amendments
782    Senate  19940331      Committee Report: Favorable     13
                             with amendment
782    Senate  19930518      Introduced, read first time,    13
                             referred to Committee
View additional legislative information at the LPITS web site.


(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

(A468, R524, S782)

AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTIONS 43-7-60, 43-7-70, 43-7-80, AND 43-7-90 SO AS TO PROVIDE FOR THE CRIMES OF MEDICAL ASSISTANCE PROVIDER FRAUD AND MEDICAL ASSISTANCE RECIPIENT FRAUD AND TO PROVIDE CIVIL AND CRIMINAL PENALTIES FOR VIOLATIONS; TO MAKE IT UNLAWFUL FOR A PROVIDER OF MEDICAL ASSISTANCE, GOODS, OR SERVICES UNDER THE STATE'S MEDICAID PROGRAM TO FAIL TO MAINTAIN SEPARATE ACCOUNTS FOR PATIENT FUNDS AND ACCURATE RECORDS WHEN REQUIRED TO DO SO BY STATE OR FEDERAL LAW, REGULATION, OR POLICY, TO MAKE IT UNLAWFUL FOR A PROVIDER TO REMOVE, TRANSFER, OR OTHERWISE USE THESE PATIENT FUNDS FOR A PURPOSE OTHER THAN THAT WHICH IS AUTHORIZED, AND TO PROVIDE CIVIL AND CRIMINAL PENALTIES FOR VIOLATIONS; TO AUTHORIZE THE ATTORNEY GENERAL TO INVESTIGATE AND INITIATE APPROPRIATE ACTION FOR ALLEGED OR SUSPECTED VIOLATION; TO PROVIDE THAT THE OFFENSES CREATED BY THIS ACT ARE NOT EXCLUSIVE AND MUST NOT BE CONSTRUED TO LIMIT THE POWER OF THE STATE TO PROSECUTE A PERSON FOR CONDUCT WHICH CONSTITUTES A CRIME UNDER ANOTHER STATUTE OR AT COMMON LAW; TO ADD SECTION 44-7-325 SO AS TO PROVIDE FOR THE FEES THAT A HEALTH CARE FACILITY OR LICENSED HEALTH CARE PROVIDER MAY CHARGE FOR PROVIDING A COPY OF A PATIENT'S MEDICAL RECORD AND FOR PRODUCING AN X-RAY AND TO PROVIDE THE TIME WITHIN WHICH A RECORD MUST BE PROVIDED; TO AMEND SECTION 38-77-341, SECTION 42-15-95, AS AMENDED, AND SECTION 44-115-80, ALL RELATING TO CHARGES FOR COPIES OF A PATIENT'S MEDICAL RECORD, SO AS TO PROVIDE THE FEES THAT A HEALTH CARE FACILITY OR LICENSED HEALTH CARE PROVIDER MAY CHARGE FOR PROVIDING A COPY OF A PATIENT'S MEDICAL RECORD AND FOR PRODUCING AN X-RAY; AND TO AMEND SECTION 44-29-230, RELATING TO TESTING IF A HEALTH CARE WORKER IS EXPOSED TO HUMAN IMMUNODEFICIENCY VIRUS, SO AS TO INCLUDE EMERGENCY RESPONSE EMPLOYEES TO INCLUDE EXPOSURE TO ALL BLOODBORNE DISEASES TO REVISE THE CRITERIA FOR MANDATORY TESTING AND REPORTING OF TEST RESULTS AND TO PROVIDE IMMUNITY TO THOSE CONDUCTING THE TEST OR REPORTING THE TEST RESULTS.

Be it enacted by the General Assembly of the State of South Carolina:

Definitions, making false statement

SECTION 1. The 1976 Code is amended by adding:

"Section 43-7-60. (A) For purposes of this section:

(1) `provider' includes a person who provides goods, services, or assistance and who is entitled or claims to be entitled to receive reimbursement, payment, or benefits under the state's Medicaid program. `Provider' also includes a person acting as an employee, representative, or agent of the provider.

(2) `false claim, statement, or representation' means a claim, statement, or representation made or presented in any form including, but not limited to, a claim, statement, or representation which is computer generated or transmitted or made, produced, or transmitted by an electronic means or device.

(B) It is unlawful for a provider of medical assistance, goods, or services to knowingly and wilfully make or cause to be made a false claim, statement, or representation of a material fact:

(1) in an application or request, including an electronic or computer generated claim, for a benefit, payment, or reimbursement from a state or federal agency which administers or assists in the administration of the state's medical assistance or Medicaid program; or

(2) on a report, certificate, or similar document, including an electronic or computer generated claim, submitted to a state or federal agency which administers or assists in the administration of the state's Medicaid program in order for a provider or facility to qualify or remain qualified under the state's Medicaid program to provide assistance, goods, or services, or receive reimbursement, payment, or benefit for this assistance, goods, or services.

For purposes of this subsection, each false claim, representation, or statement constitutes a separate offense.

(C) It is unlawful for a provider of medical assistance, goods, or services knowingly and wilfully to conceal or fail to disclose any material fact, event, or transaction which affects the:

(1) provider's initial or continued entitlement to payment, reimbursement, or benefits under the state's Medicaid plan; or

(2) amount of payment, reimbursement, or benefit to which the provider may be entitled for services, goods, or assistance rendered. For purposes of this subsection, each fact, event, or transaction concealed or not disclosed constitutes a separate offense.

(D) A person who violates the provisions of this section is guilty of medical assistance provider fraud, a Class A misdemeanor and, upon conviction, must be imprisoned not more than three years and fined not more than one thousand dollars for each offense.

(E) In addition to all other remedies provided by law, the Attorney General may bring an action to recover damages equal to three times the amount of an overstatement or overpayment and the court may impose a civil penalty of two thousand dollars for each false claim, representation, or overstatement made to a state or federal agency which administers funds under the state's Medicaid program. Upon a finding that the provider has violated a provision of this section, the state agency which administers the Medicaid program may impose other administrative sanctions against the provider authorized by law. A civil or criminal action brought under this section may be filed or brought in either the county where the false claim, statement, or representation originated or in the county in which the false claim, statement, or representation was received by the Health and Human Services Finance Commission or other agency of the State responsible for administering the state's Medicaid Program.

Section 43-7-70. (A) (1) It is unlawful for a person to knowingly and wilfully to make or cause to be made a false statement or representation of material fact on an application for assistance, goods, or services under the state's Medicaid program when the false statement or representation is made for the purpose of determining the person's entitlement to assistance, goods, or services.

(2) It is unlawful for any applicant, recipient, or other person acting on behalf of the applicant or recipient knowingly and wilfully to conceal or fail to disclose any material fact affecting the applicant's or recipient's initial or continued entitlement to receive assistance, goods, or services under the state's Medicaid program.

(3) It is unlawful for a person eligible to receive benefits, services, or goods under the Medicaid program to sell, lease, lend, or otherwise exchange rights, privileges, or benefits to another person. (B) A person who violates the provisions of this section is guilty of medical assistance recipient fraud, a Class A misdemeanor and, upon conviction, must be imprisoned not more than three years or fined not more than one thousand dollars, or both.

Section 43-7-80. (A) A provider of medical assistance, goods, or services under the state's Medicaid program who is required by state or federal law, regulation, or written policy to maintain separate accounts for patient funds and accurate records of those funds must maintain separate accounts and records of the accounts. It is unlawful for a provider, or a person acting as the provider's agent or employee, to transfer, remove, or encumber or cause to be removed, transferred, or encumbered patient funds for a purpose other than as authorized. Repayment or retransfer of patient funds or satisfaction of an encumbrance on them is not a defense under this section and repayment, retransfer, or satisfaction is admissible as relevant evidence only at sentencing, if the provider is found guilty of a violation of this section.

(B) A person who violates the provisions of this section is guilty of a Class A misdemeanor and, upon conviction, must be imprisoned not more than three years and fined not more than one thousand dollars.

(C) In addition to all other remedies under this section, the Attorney General may bring an action to recover damages equal to five thousand dollars for each violation of this section. Upon a finding that a provider has violated a provision of this section, the state agency which administers the Medicaid program also may take other administrative action authorized under relevant state or federal laws.

Section 43-7-90. The Attorney General has the authority and responsibility to investigate and initiate appropriate action for alleged or suspected violations of Sections 43-7-60 through 43-7-80."

Offenses not exclusive

SECTION 2. The offenses created by this act are not exclusive and must not be construed to limit the power of the State to prosecute a person for conduct which constitutes a crime under another statute or at common law.

Fees may be charged

SECTION 3. The 1976 Code is amended by adding:

"Section 44-7-325. (A) A health care facility, as defined in Section 44-7-130, and a health care provider licensed pursuant to Title 40 may charge a fee for the search and duplication of a medical record, but the fee may not exceed sixty-five cents per page for the first thirty pages and fifty cents per page for all other pages, and a clerical fee for searching and handling not to exceed fifteen dollars per request plus actual postage and applicable sales tax. However, no fee may be charged for records copied at the request of a health care provider or for records sent to a health care provider at the request of the patient for the purpose of continuing medical care. The facility or provider may charge a patient or the patient's representative no more than the actual cost of reproduction of an X-ray. Actual cost means the cost of materials and supplies used to duplicate the X-ray and the labor and overhead costs associated with the duplication.

(B) Except for those requests for medical records pursuant to Section 42-15-95:

(1) A health care facility shall comply with a request for copies of a medical record no later than forty-five days after the patient has been discharged or forty-five days after the request is received, whichever is later.

(2) Nothing in this section may compel a health care facility to release a copy of a medical record prior to thirty days after discharge of the patient."

Fees, etc.

SECTION 4. Section 38-77-341(5) of the 1976 Code, as added by Act 148 of 1989, is amended to read:

"(5) in the case of a health care facility, as defined in Section 44-7-130, and a health care provider licensed pursuant to Title 40, charge a fee for:

(a) the search for and duplication of a medical record, in excess of sixty-five cents per page for the first thirty pages and fifty cents per page for all other pages;

(b) searching and handling a medical record in excess of fifteen dollars per request plus actual postage and applicable sales tax;

(c) records copied at the request of a health care provider or for records sent to a health care provider at the request of a patient for the purpose of continuing medical care;

(d) more than the actual cost of reproduction of an X-ray. Actual cost means the cost of materials and supplies used to duplicate the X-ray and the labor and overhead costs associated with the duplication."

Fees, etc.

SECTION 5. Section 42-15-95 of the 1976 Code, as last amended by Act 476 of 1990, is further amended to read:

"Section 42-15-95. All existing information compiled by a health care facility, as defined in Section 44-7-130, or a health care provider licensed pursuant to Title 40 pertaining directly to a workers' compensation claim must be provided to the insurance carrier, the employer, the employee, their attorneys, or the South Carolina Workers' Compensation Commission, within fourteen days after receipt of written request. A health care facility and a health care provider may charge a fee for the search and duplication of a medical record, but the fee may not exceed sixty-five cents per page for the first thirty pages and fifty cents per page for all other pages, and a clerical fee for searching and handling not to exceed fifteen dollars per request plus actual postage and applicable sales tax. The facility or provider may charge a patient or the patient's representative no more than the actual cost of reproduction of an X-ray. Actual cost means the cost of materials and supplies used to duplicate the X-ray and the labor and overhead costs associated with the duplication. If a treatment facility or physician fails to send the requested information within forty-five days after receipt of the request, the person or entity making the request may apply to the commission for an appropriate penalty payable to the commission, not to exceed two hundred dollars."

Fees, etc.

SECTION 6. Section 44-115-80 of the 1976 Code, as added by Act 480 of 1992, is amended to read:

"Section 44-115-80. A physician may charge a fee for the search and duplication of a medical record, but the fee may not exceed sixty-five cents per page for the first thirty pages and fifty cents per page for all other pages, and a clerical fee for searching and handling not to exceed fifteen dollars per request plus actual postage and applicable sales tax. However, no fee may be charged for records copied at the request of a health care provider or for records sent to a health care provider at the request of the patient for the purpose of continuing medical care. The physician may charge a patient or the patient's representative no more than the actual cost of reproduction of an X-ray. Actual cost means the cost of materials and supplies used to duplicate the X-ray and the labor and overhead costs associated with the duplication."

Testing

SECTION 7. Section 44-29-230 of the 1976 Code, as added by Act 490 of 1988, is amended to read:

"Section 44-29-230. (A) While working with a person or a person's blood or body fluids, if a health care worker or emergency response employee is involved in an incident resulting in possible exposure to bloodborne diseases, and a health care professional based on reasonable medical judgment has cause to believe that the incident may pose a significant risk to the health care worker or emergency response employee, the health care professional may require the person, the health care worker, or the emergency response employee to be tested without his consent.

(B) The test results must be given to the health care professional who shall report the results and assure the provision of post-test counseling to the health care worker or emergency response employee, and the person who is tested. The test results also shall be reported to the Department of Health and Environmental Control in a manner prescribed by law.

(C) No physician, hospital, or other health care provider may be held liable for conducting the test or the reporting of test results under this section.

(D) For purposes of this section:

(1) `Person' means a patient at a health care facility or physician's office, an inmate at a state or local correctional facility, an individual under arrest, or an individual in the custody of or being treated by a health care worker or an emergency response employee.

(2) `Emergency response employee' means firefighters, law enforcement officers, paramedics, emergency medical technicians, medical residents, medical trainees, trainees of an emergency response employee as defined herein, and other persons, including employees of legally organized and recognized volunteer organizations without regard to whether these employees receive compensation, who in the course of their professional duties respond to emergencies.

(3) `Bloodborne diseases' means Hepatitis B or Human Immunodeficiency Virus infection, including Acquired Immunodeficiency Syndrome.

(4) `Significant risk' means a finding of facts relating to a human exposure to an etiologic agent for a particular disease, based on reasonable medical judgments given the state of medical knowledge, about the:

(a) nature of the risk;

(b) duration of the risk;

(c) severity of the risk;

(d) probabilities the disease will be transmitted and will cause varying degrees of harm.

(5) `Health care professional' means a physician, an epidemiologist, or infection control practitioner.

(6) `Health care worker' means a person licensed as a health care provider under Title 40, a person registered under the laws of this State to provide health care services, an employee of a health care facility as defined in Section 44-7-130(10), or an employee in a physician's office.

(E) The cost of any test conducted under this section must be paid by the:

(1) person being tested;

(2) State in the case of indigents; or

(3) public or private entity employing the health care worker or emergency response employee if the cost is not paid pursuant to subitems (1) and (2) above."

Time effective

SECTION 8. This act takes effect upon approval by the Governor.

Approved the 14th day of July, 1994.