Communications
Public Notices
Waiver Renewal for the Community Choices (CC) and HIV/AIDS Waivers
The South Carolina Department of Health and Human Services (SCDHHS) gives notice that it intends to file waiver renewals with the Centers for Medicare and Medicaid Services (CMS) for the Community Choices (SC.0405) and HIV/AIDS (SC.0186) Home and Community-Based Services (HCBS) waivers operated through the Division of Health Programs. The proposed effective date of these waivers is July 1, 2021.
Post date: 02/26/2021 - 5:29pm
Public Notice of Final Action for Medication-Assisted Treatment
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding the new Medication-Assisted Treatment (MAT) section under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 02/18/2021 - 3:35pm
Heightened Scrutiny Category 2 Settings: Submission to CMS; South Carolina Home and Community-Based Services Statewide Transition Plan updates
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) Rule at 42 CFR 441.301(c)(6), gives notice that:
Post date: 02/10/2021 - 10:12am
Palmetto Coordinated System of Care 1915(c) Waiver Amendment
The South Carolina Department of Health and Human Services (SCDHHS) gives notice that an amendment to the approved 1915(c) Palmetto Coordinated System of Care (PCSC [SC.1686.R00.00]) Home and Community Based Services (HCBS) waiver will be submitted to the Centers for Medicare and Medicaid Services (CMS). The approved effective date of the existing waiver is Aug. 1, 2020. The proposed waiver amendment will become effective upon CMS approval.
Post date: 01/25/2021 - 3:23pm
Final Action for Setting Payment Rates for Long Term Care Facility Services (Excluding State-Owned Nursing Facilities)
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following actions regarding its methods and standards for setting payment rates for long-term care facility services (excluding state-owned nursing facilities) under the South Carolina Medicaid State Plan (State Plan) under Title XIX of the Social Security Act Medical Assist
Post date: 12/31/2020 - 10:55am
Final Action for FFY 2021 DSH Payments and Swing Bed Hospital and Administrative Day Rates
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following actions regarding its methods and standards for establishing Medicaid Disproportionate Share Hospital (DSH) payments to qualifying DSH hospitals and for updating the swing bed hospital and administrative day rates.
Post date: 12/31/2020 - 10:08am
State Community Engagement Implementation Task Force
The purpose of this task force is to coordinate the efforts of those agencies and entities necessary to implement the Healthy Connections Community Engagement Initiative, as outlined in Executive Order
Post date: 12/15/2020 - 5:01pm
Amendment for the Medically Complex Children (MCC) Waiver
Post date: 12/11/2020 - 2:55pm
Proposed Action for Setting Payment Rates for Long Term Care Facility Services (Excluding State-Owned Nursing Facilities)
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following proposed actions regarding its methods and standards for setting payment rates for long-term care facility services (excluding state-owned nursing facilities) under the South Carolina Medicaid State Plan (State Plan) under Title XIX of the Social Security Act Medic
Post date: 11/30/2020 - 3:13pm
Proposed Action for FFY 2021 DSH Payments and Swing Bed Hospital and Administrative Day Rates
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following proposed actions regarding its methods and standards for establishing Medicaid Disproportionate Share Hospital (DSH) payments to qualifying DSH hospitals and for updating the swing bed hospital and administrative day rates.
Post date: 11/24/2020 - 4:27pm
Amendment for the Medically Complex Children (MCC) Waiver
Post date: 10/19/2020 - 8:09pm
Public Notice of Final Action for Professional Service Fee Schedules
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding reimbursement methodologies and rates for certain services provided under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/30/2020 - 4:00pm
Public Notice of Final Action for Medicaid Coverage of Contraceptives
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action to allow coverage for a 12-month supply of systemic contraceptives through Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/29/2020 - 11:48am
Public Notice of Final Action for Early Intervention/Family Training Services Program Rate Increase
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following action regarding its methods and standards for setting payments for the Early Intervention/Family Training Services Program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/10/2020 - 10:42am
Public Notice of Proposed Action for Medicaid Coverage of Contraceptives
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following proposed action to allow coverage for a 12-month supply of systemic contraceptives through Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/28/2020 - 10:45am
Final Action for the Introduction of Therapeutic Foster Care for Child Medicaid Beneficiaries
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding the introduction of a therapeutic foster care (TFC) benefit for child Medicaid beneficiaries under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/28/2020 - 10:17am
Public Notice of Final Action for Covered Outpatient Drug Reimbursement Methodology Update
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding reimbursement methodology for covered outpatient drugs (COD) purchased through the pharmacy program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/14/2020 - 1:25pm
Public Notice of Final Action for the Supplemental Teaching Physician (STP) Payment Program
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following action regarding its methods and standards for setting payments for the Supplemental Teaching Physician (STP) Payment Program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 03/30/2020 - 11:10am
Public Notice of Proposed Action for the Supplemental Teaching Physician (STP) Payment Program
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following proposed action regarding its methods and standards for setting payments for the Supplemental Teaching Physician (STP) Payment Program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 02/28/2020 - 2:19pm
Amendment for the Community Choices Waiver and Waiver Specific Transition Plan
South Carolina Department of Health and Human Services (SCDHHS) intends to file an amendment with the Centers for Medicare and Medicaid Services (CMS) for the Community Choices (SC.0405) Home and Community-Based Services (HCBS) waiver operated through the Community Long Term Care (CLTC) program. The approved effective date of the existing waiver is July 1, 2016.
Post date: 02/21/2020 - 1:27pm
Pages
Provider Alerts
Feb 18, 2021
Feb 5, 2021
Jan 22, 2021
Latest Press Releases 
Jul 7, 2020
The South Carolina Department of Health and Human Services (SCDHHS) announced it will immediately begin accepting applications for a new limited-benefit Medicaid coverage group to provide reimbursement for coronavirus disease 2019 (COVID-19) testing for those without healthcare coverage. SCDHHS’ COVID-19 Limited Benefit Program was authorized by the Families First Coronavirus Response Act (FFCRA) and will provide additional financial support to increase access to testing, a critical component of the state’s response to addressing the pandemic, for South Carolinians without other sources of healthcare coverage.
Mar 31, 2017
Governor Henry McMaster today announced Christian L. Soura’s resignation as Director of the South Carolina Department of Health and Human Services, effective April 7, 2017.
Jun 2, 2016
South Carolina Birth Outcomes Initiative Wins National Award for Innovative Strategies to Improve Health of Moms and Babies
Feb 23, 2016
Beginning April 1, the South Carolina Department of Health and Human Services (SCDHHS) will require that providers verify Medicaid members' controlled substance prescription history before issuing prescriptions for opioids
Reports / Statistics
Posted: 02/03/2021 - 11:39am
The South Carolina Department of Health and Human Services (SCDHHS) engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and wasteful practices on the part of healthcare providers. Not only is this mandated by federal regulations found in 42 CFR 455, it is critical because of the need to assure that public resources are properly managed.
Posted: 04/09/2020 - 3:03pm
Posted: 01/29/2020 - 2:38pm
Posted: 12/12/2019 - 10:04am
The South Carolina Department of Health and Human Services (SCDHHS) engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and wasteful practices on the part of healthcare providers. Not only is this mandated by federal regulations found in 42 CFR 455, it is critical because of the need to assure that public resources are properly managed.
Posted: 03/21/2019 - 4:12pm
Posted: 12/13/2018 - 8:27am
The South Carolina Department of Health and Human Services (SCDHHS) engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and excessive practices on the part of healthcare providers. Not only is this mandated by federal regulations found in 42 CFR 455, it is even more critical because of the need to better manage scarce public resources in a time of rising demand and decreasing tax dollars. The department is committed to increasing the quality and number of cases referred to the SC Attorney General's Office for fraud and the recovery of funds lost due to fraud, waste and abuse.
Posted: 04/01/2018 - 4:22pm
Posted: 02/02/2018 - 3:27pm
Posted: 12/05/2017 - 4:36pm
The South Carolina Department of Health and Human Services (SCDHHS) engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and excessive practices on the part of healthcare providers. Not only is this mandated by federal regulations found in 42 CFR 455, it is even more critical because of the need to better manage scarce public resources in a time of rising demand and decreasing tax dollars. The department is committed to increasing the quality and number of cases referred to the SC Attorney General's Office for fraud and the recovery of funds lost due to fraud, waste and abuse.
Posted: 04/01/2017 - 2:44pm
Posted: 02/03/2017 - 10:50am
Posted: 01/19/2017 - 2:16pm
Submitted April 1, 2016
The South Carolina Department of Health and Human Services (SCDHHS) engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and excessive practices on the part of healthcare providers. Not only is this mandated by federal regulations found in 42 CFR 455, it is even more critical because of the need to better manage scarce public resources in a time of rising demand and decreasing tax dollars. The department is committed to increasing the quality and number of cases referred to the SC Attorney General’s Office for fraud and the recovery of funds lost due to fraud, waste and abuse.
The National Health Care Anti-Fraud Association estimates that financial losses due to health care fraud are in the tens of billions of dollars each year. Other estimates by government and law enforcement agencies such as the FBI place the loss due to health care fraud as high as 10 percent of annual health care expenditures. Federal regulations define fraud as “intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.” (42CFR 455.2) Medicaid fraud is a criminal matter. Waste, improper claims, billing errors, and abuse also cause losses of Medicaid funds but are not criminal actions.
SCDHHS receives fraud “tips” from its fraud hotline and also conducts extensive data mining to identify potential fraud cases. Federal regulations require SCDHHS to conduct a preliminary investigation upon suspicion of fraud and then refer the cases to the Medicaid Fraud Control Unit (MFCU) in the SC Attorney General’s Office. Cases are also referred to the MFCU from other sources, such as the FBI, the federal Office of Inspector General, other state agencies, and the MFCU’s own fraud hotline. SCDHHS’ Division of Program Integrity conducts these preliminary investigations and collaborates with the MFCU on all fraud cases. Fraud cases can take several years before final adjudication and the collection of any penalties or claim refunds by SCDHHS.
The MFCU also participates in national global cases that arise in connection with a U.S. Department of Justice investigation. Those cases oftentimes involve manipulation of wholesale drug prices by pharmaceutical companies to increase Medicaid payments. While considered fraud cases, they are prosecuted as civil cases as opposed to criminal cases. In calendar year 2015 thirteen (13) settlements resulted from cases originating out of the National Association of Medicaid Fraud Control Unit (NAMFCU) actions resulting in recoveries of $6,606,395.75.
The following table illustrates Medicaid provider fraud cases that were opened during calendar year 2015 and reflects the number of settlements and convictions that occurred during calendar year 2015. The percent of fraud cases referred by SCDHHS was 27%. Total 2015 calendar year recoveries were $11,866,071.32. Federal laws and regulations require the return of the federal share of Medicaid funds recovered. Approximately 68% of the recovered amount must be returned to the federal government. SCDHHS can retain the state share (approximately 32%) of the recoveries and re-use the funds to again match federal monies for the on-going operation of the Medicaid program.
| Provider Fraud Cases | |
| New Provider Fraud Cases Opened * | 94 |
| Active * | 54 |
| Closed * | 40 |
| Number / % Referred by SCDHHS # | 21 / 27% |
| Results | |
| Recovered as a result of Provider Fraud Convictions/Referrals1 | $467,695.24 |
| Recoveries from all other PI cases1,2 | $4,791,980.33 |
| Convictions | 12 |
| National Association of Medicaid Fraud Control Units (NAMFCU) | |
| # Of Cases Settled | 13 |
| Amounts Recovered1 | $6,606,395.75 |
1. All dollars shown are combined federal and state. Some of the recoveries in 2015 are from cases opened in prior year(s).
2. Program Integrity recoveries due to cases for waste, overpayments, improper payments, and abuse that were not referred for potential fraud.
* Includes Globals
# Does Not Include Globals
Posted: 04/01/2016 - 12:02pm
Posted: 03/16/2016 - 2:36pm
Posted: 02/03/2016 - 9:57am
Posted: 12/08/2015 - 3:46pm
Posted: 10/21/2015 - 5:01pm
Submitted April 1, 2015
The South Carolina Department of Health and Human Services (SCDHHS) engages in an on-going effort to prevent and identify fraud in the Medicaid program, and to recover the funds lost because of fraudulent and excessive practices on the part of healthcare providers. Not only is this mandated by federal regulations found in 42 CFR 455, it is even more critical because of the need to better manage scarce public resources in a time of rising demand and decreasing tax dollars. The department is committed to increasing the quality and number of cases referred to the SC Attorney General's Office for fraud and the recovery of funds lost due to fraud, waste and abuse.
The National Health Care Anti-Fraud Association estimates that financial losses due to health care fraud are in the tens of billions of dollars each year. Other estimates by government and law enforcement agencies such as the FBI place the loss due to health care fraud as high as 10 percent of annual health care expenditures. Federal regulations define fraud as ¡§intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.¡¨ (42CFR 455.2) Medicaid fraud is a criminal matter. Waste, improper claims, billing errors, and abuse also cause losses of Medicaid funds but are not criminal actions.
SCDHHS receives fraud ¡§tips¡¨ from its fraud hotline and also conducts extensive data mining to identify potential fraud cases. Federal regulations require SCDHHS to conduct a preliminary investigation upon suspicion of fraud and then refer the cases to the Medicaid Fraud Control Unit (MFCU) in the SC Attorney General¡¦s Office. Cases are also referred to the MFCU from other sources, such as the FBI, the federal Office of Inspector General, other state agencies, and the MFCU¡¦s own fraud hotline. SCDHHS¡¦ Division of Program Integrity conducts these preliminary investigations and collaborates with the MFCU on all fraud cases. Fraud cases can take several years before final adjudication and the collection of any penalties or claim refunds by SCDHHS. In general, healthcare fraud involves filing a false claim for Medicaid payments, which can include services that were never provided, or were provided but were not medically necessary. The MFCU also participates in national cases against pharmaceutical companies that manipulate wholesale prices on drugs to get more money from Medicaid. While these are also considered fraud cases, they are prosecuted as civil cases as opposed to criminal cases.
The following table reports Medicaid provider fraud cases that were opened during calendar year 2014 updated for the most current data available through December 31, 2014; the amounts recovered by the Attorney General¡¦s Office and Program Integrity and the number of convictions for the same time frame; and the number of recoveries from civil settlements in the national pharmaceutical cases. The federal share of the Medicaid funds recovered (approximately 68%) must be returned; SCDHHS can retain the state share of these recoveries and use it to again match federal monies for the on-going operation of the Medicaid program.
The total number of on-going cases for Medicaid provider fraud at the Attorney General¡¦s totaled 136, to include pharmaceutical cases, as of December 31, 2014; 79 of these cases were referred by SCDHHS. This includes cases that were opened in previous years (and therefore not counted in the table below) but are still on-going as of the January 16, 2015, based on the Provider Case List provided by the Attorney General¡¦s Office.
| Provider Fraud Cases | |
| New Provider Fraud Cases Opened * | 78 |
| Active * | 38 |
| Closed * | 40 |
| Number / % Referred by SCDHHS # | 24 / 30.77 % |
| Results | |
| Recovered as a result of Provider Fraud Convictions/Referrals (1) | $246,512.64 |
| Recoveries from all other PI cases (2) | $4,382,490.82 |
| Convictions | 11 |
| Pharmaceutical Manufacturer Cases | |
| # Of Cases Settled | 18 |
| Amounts Recovered (3) | $21,524,869.91 |
- All dollars shown are federal and state; the state share is approximately 32%. Some of the recoveries in 2014 are from cases opened in prior year(s).
- Program Integrity recoveries due to cases for waste, overpayments, improper payments, and abuse that were not referred for potential fraud.
- 58% of the recoveries from global pharmaceutical manufacturer cases are state funds.
* Includes Pharmaceuticals # Does Not Include Pharmaceuticals
Posted: 04/01/2015 - 10:56am
Posted: 03/19/2015 - 1:54pm