S*782 Session 110 (1993-1994)
S*0782(Rat #0524, Act #0468) General Bill, By M.T. Rose and Giese
A Bill 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 a 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 that 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.-a
05/18/93 Senate Introduced and read first time SJ-7
05/18/93 Senate Referred to Committee on Medical Affairs SJ-8
03/31/94 Senate Committee report: Favorable with amendment
Medical Affairs SJ-7
04/05/94 Senate Amended SJ-23
04/05/94 Senate Read second time SJ-24
04/05/94 Senate Ordered to third reading with notice of
amendments SJ-24
04/06/94 Senate Read third time and sent to House SJ-17
04/07/94 House Introduced and read first time HJ-6
04/07/94 House Referred to Committee on Judiciary HJ-7
05/24/94 House Committee report: Favorable with amendment
Judiciary HJ-8
06/01/94 House Amended HJ-388
06/01/94 House Read second time HJ-394
06/02/94 House Read third time and returned to Senate with
amendments HJ-22
06/02/94 Senate Concurred in House amendment and enrolled SJ-36
06/02/94 Ratified R 524
07/14/94 Signed By Governor
07/14/94 Effective date 07/14/94
07/26/94 Copies available
(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. |