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Waiver Renewal for the Mechanical Ventilator Dependent Waiver and Waiver Specific Transition Plan

  The South Carolina Department of Health and Human Services (SCDHHS) intends to file waiver renewal with the Centers for Medicare and Medicaid Services (CMS) for the Mechanical Ventilator Dependent (SC.40181) Home and Community-based (HCB) Waiver operated through the Community Long Term Care (CLTC) program.  The effective date for the proposed waiver renewal changes is Dec. 1, 2017 or upon CMS approval.   
Post date: 07/14/2017 - 2:17pm

Public Notice of Final Actions for Autism Spectrum Disorder (ASD)

The South Carolina Department of Health and Human Services gives notice of the following action regarding Autism Spectrum Disorder (ASD) Services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/30/2017 - 3:17pm

Public Notice of Final Actions for Dental Fee Schedule 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 actions regarding its methods and standards for setting payment rates for Dental services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/28/2017 - 4:42pm

Public Notice of Final Actions for Pharmacy Prescription Limit

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the monthly prescription limit under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/28/2017 - 4:48pm

Public Notice of Final Actions for Pharmacy Benefit Co-Payments

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the prescription co-payments under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/28/2017 - 4:45pm

Public Notice of Final Actions for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

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 paying providers under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/22/2017 - 5:03pm

Public Notice of Final Actions for Federally Qualified Health Care Centers (FQHCs)

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 Federally Qualified Health Care Centers (FQHCs) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/22/2017 - 5:05pm

Public Notice of Final Actions for the South Carolina Department of Mental Health (SCDMH) Clinic 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 action regarding its methods and standards for paying providers under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/22/2017 - 5:08pm

Public Notice of Final Actions for Former Foster Care Youth-Coordinated Care

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding coverage of former Foster Care youth under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 06/15/2017 - 4:12pm

Proposed Actions for Pharmacy Benefit Co-Payments

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following proposed actions regarding the prescription co-payments under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/25/2017 - 4:29pm

Proposed Actions for Pharmacy Prescription Limit

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following proposed actions regarding the monthly prescription limit under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/25/2017 - 4:26pm

Proposed Actions for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

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 paying providers under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/17/2017 - 2:20pm

Public Notice of Proposed Actions for Federally Qualified Health Care Centers (FQHCs)

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 Federally Qualified Health Care Centers (FQHCs) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/17/2017 - 2:24pm

Proposed Actions for the South Carolina Department of Mental Health (SCDMH) Clinic 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 action regarding its methods and standards for paying providers under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/17/2017 - 1:59pm

Proposed Palmetto Coordinated System of Care Waiver Program

The South Carolina Department of Health and Human Services (SCDHHS) gives notice that a proposed application for the Palmetto Coordinated System of Care (PCSC) waiverwill be submitted to the Centers of Medicaid and Medicare (CMS) and is available for public review and comment.
Post date: 05/02/2017 - 10:06am

Public Notice of Proposed Actions for Former Foster Care Youth—Coordinated Care

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following proposed actions regarding coverage of former Foster Care youth under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 05/01/2017 - 1:54pm

Public Hearings for Proposed Regulations

A public hearing before the Honorable Deborah Brooks Durden, Administrative Law Judge, will be held beginning at 3 p.m. Tuesday, April 18, 2017, on the South Carolina Department of Health and Human Services' (SCDHHS) Proposed Regulations Document No. 4746. The hearing will be held at the Administrative Law Court in the second floor hearing room of the Edgar A. Brown building located at 1205 Pendleton Street in Columbia.
Post date: 04/13/2017 - 4:31pm

SCDHHS Seeks Public Comments on BabyNet

Pursuant to Executive Order 2016-20 and effective July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will assume lead agency designation for the Individuals with Disabilities Education Act (IDEA) Part C program, known in South Carolina as “BabyNet,” from South Carolina First Steps to School Readiness.
Post date: 04/06/2017 - 1:25pm

Final Public Notice for 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: 03/31/2017 - 2:07pm

Proposed Public Notice for Autism Spectrum Disorder (ASD)

The South Carolina Department of Health and Human Services gives notice of the following proposed action regarding Autism Spectrum Disorder (ASD) Services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Post date: 03/31/2017 - 1:26pm

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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

Submitted April 1, 2014

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 numbers 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 fraud accounts for 3 percent of the nation's annual health care spending. 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 an 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 US Department of Health and Human Services - 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 2013 updated for the most current data available through February 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 69% - 70%) 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 Office totaled 104 as of February 2014; 78 of these cases resulted from referrals by SCDHHS. This includes cases that were opened in previous years (and therefore not counted in the table below) but are still on-going.

MEDICAID FRAUD CASES 2013

  CY 2013
Provider Fraud Cases
New Provider Fraud Cases Opened 45
# / % Referred by SCDHHS 29 / 64%
Current Status:
Active 14
Closed 4
Results
Recovered from Provider Fraud Cases (1) $1,239,860.19
Recoveries from all other Program Integrity cases (2) $9,377,884.99
Convictions 17
Pharmaceutical Manufacturer Cases
# of Cases with Recoveries 21
Amounts Recovered $14,793,812.80

(1) All dollars shown are Federal and State. Some of the recoveries in 2013 are from cases opened in prior year(s).

(2) Program Integrity recoveries due to cases for waste, overpayments, improper payments, and a that were not referred for potential fraud.

Print Version

Posted: 04/02/2014 - 2:52pm

SCDHHS Budget Presentation

Tony Keck, Director
February 5, 2014

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Posted: 02/06/2014 - 9:57am

SCDHHS Budget Presentation

FY 2013 Year End

Tony Keck, Director
December 4, 2013
 

Posted: 12/04/2013 - 5:06pm

John Supra
McLaughlin, Smoak & Clarke Benefits Forum
August 16, 2013

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Posted: 08/19/2013 - 11:14am

The South Carolina Department of Health and Human Services (SCDHHS) releases its findings on current regulatory burdens on businesses.

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Posted: 06/07/2013 - 9:07am

Posted: 04/22/2013 - 10:45am

  • Reduce the per capita cost of health care
  • Improve the health of populations
  • Improve the patient experience (quality and satisfaction)
 

Posted: 01/24/2013 - 4:08pm

Section 1: Purchasing Health in SC
Section 2: FY 2013 Update
Section 3:  FY 2014 Budget Request
 

Posted: 01/17/2013 - 2:45pm

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