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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING ARTICLE 8, CHAPTER 6, TITLE 44 SO AS TO ESTABLISH THE STATE OFFICE OF MEDICAID AND HEALTH CARE AUDITS FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO PROVIDE THAT THE AUDIT DIRECTOR MUST BE APPOINTED BY THE GOVERNOR, AND TO FURTHER PROVIDE FOR THE POWERS AND DUTIES OF THE AUDIT DIRECTOR, INCLUDING CONDUCTING AUDITS, PREVENTING WASTE, AND PROMOTING ACCOUNTABILITY.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 6, Title 44 of the 1976 Code is amended by adding:
Section 44-6-1010. (A) There is established the State Office of Medicaid and Health Care Audits for the Department of Health and Human Services for the purpose of:
(1) conducting independent and objective audits, reviews, investigations, and inspections;
(2) preventing and detecting waste, fraud, and abuse;
(3) promoting accountability, economy, effectiveness, and efficiency.
(B) Agencies under the purview of this office are the:
(1) Department of Social Services;
(2) Department of Disabilities and Special Needs;
(3) Department of Mental Health.
(C) The audit director must be appointed by the Governor without regard to political affiliation and solely on the basis of integrity, related experience, and demonstrated ability in accounting, auditing, financial analysis, and management analysis. Employees of the office serve at the pleasure of the director.
Section 44-6-1020. In carrying out the duties of the office the audit director may:
(1) conduct audits, reviews, analyses, investigations, and inspections relating to the administration and operation of all programs administered by the department;
(2) conduct audits, reviews, analyses, investigations, and inspections of providers, recipients, and other entities doing business with the department to determine compliance with applicable departmental contracts and regulations and to detect related fraud and abuse, if any;
(3) receive and investigate complaints concerning possible violations of regulations or law, gross mismanagement, fraud, waste, or abuse. The office may not disclose the identity of an individual submitting a complaint unless the disclosure is unavoidable during the course of an investigation;
(4) issue evaluation and audit reports in accordance with professional standards;
(5) have direct access to all systems, records, reports, reviews, files, documents, papers, and similar information related to the programs and operations of the department and entities doing business with the department;
(6) request information and assistance as necessary from any state, federal, or local agency;
(7) enter into contracts and make payments for necessary staff and resources to the extent, and in such amounts as provided under this section and the annual general appropriations act;
(8) instruct the department to collect or withhold amounts related to fraud and abuse findings.
(9) utilize resources of the Department of Health and Human Services both within and external to the department including, but not limited to, contracting with other entities for the purpose of expanding program integrity efforts and maximizing the ability to detect and eliminate provider fraud.
Section 44-6-1030. The audit director shall report findings of fraud or abuse to the Director of the Department of Health and Human Services and the State Attorney General.
Section 44-6-1040. If the audit director enters into a contract for assistance in carrying out the audit director's responsibilities under this article, the contract must contain a provision authorizing the audit director, or his designee, to obtain records in accordance with applicable federal laws concerning confidentiality and the release of information. The contract must specifically contain a provision that information obtained in the course of the audit must be released to the Governor upon request.
Section 44-6-1050. At least semi-annually, and more frequently at the request of the General Assembly, the audit director shall provide to the General Assembly:
(1) a description of significant problems, abuses, and deficiencies encountered in the administration and operation of departmental programs and recommendations for corrective action;
(2) a listing of each audit report issued during the period and estimates for the dollar value of costs questioned in the report;
(3) a report on each recommendation issued in an audit report over six months old, to which the appropriate entity has not complied;
(4) a status report on fraud and abuse activity, including case volumes, collections, results of reviews and investigations, and referrals to the Attorney General or other prosecutorial and law enforcement authorities;
(5) a status report on the annual audit plan that provides progress on current reviews and on known intended reviews and their completion dates;
(6) other information as requested by the committee.
Section 44-6-1060. The audit director, in carrying out the duties and responsibilities of this article, shall make every attempt to avoid duplication and ensure effective coordination and cooperation. Nothing in this section is intended to duplicate the activity of the State Auditor, the Attorney General's Medicaid Fraud Control Unit, or the Legislative Audit Council.
Section 44-6-1070. (A) The audit director shall establish a budget, and seek additional funding sources, to carry out the responsibilities of the office.
(B) Of the general funds appropriated to the agencies under the purview of this office, as provided for pursuant to Section 44-6-1010, .001 of these funds must be transferred annually by the State Treasurer from the general fund accounts of these agencies to be deposited in a separate and distinct account entitled 'State Office of Medicaid and Health Care Audits'."
SECTION 2. This act takes effect upon approval by the Governor.
This web page was last updated on Tuesday, June 23, 2009 at 2:18 P.M.