Communications

Public Notices

Public Notice of Final Action for Dental Services

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the Dental Services benefit and Medical and Surgical Services of a Dentist under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid). Effective on or after July 1, 2021, SCDHHS will amend the South Carolina Title XIX State Plan to address the following updates:
Post date: 05/07/2021 - 9:19am

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: 03/26/2021 - 3:08pm

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

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

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

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 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

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

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Latest Press Releases RSS icon

Mar 11, 2021

SCDHHS Urges CMS to Maintain Healthy Connections Community Engagement Initiative Medicaid Waiver Program Approved in 2019 Tailors Healthcare Resources to Vulnerable Populations, Provides Targeted Solution to Support Low-income Workers’ Ability to Achieve Financial Independence

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

Reports / Statistics

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.

Download Full Report

Posted: 03/17/2021 - 9:49am

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.

Read Full Report

Posted: 04/09/2020 - 3:03pm

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.

Download Full Presentation

Posted: 03/21/2019 - 4:12pm

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.

 

Download Full Presentation

Posted: 04/01/2018 - 4:22pm

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. 

Download Full Report

Posted: 04/01/2017 - 2:44pm

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.

FRAUD CASES 2015
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

 

Print Version

Posted: 04/01/2016 - 12:02pm

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.

FRAUD CASES 2014
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

 

  1. 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).
  2. Program Integrity recoveries due to cases for waste, overpayments, improper payments, and abuse that were not referred for potential fraud.
  3. 58% of the recoveries from global pharmaceutical manufacturer cases are state funds.

 

* Includes Pharmaceuticals # Does Not Include Pharmaceuticals

 

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Posted: 04/01/2015 - 10:56am

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