South Carolina Code of Regulations
Chapter 126 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
Article 4 - PROGRAM EVALUATION
Subarticle 1 - ADMINISTRATIVE SANCTIONS AGAINST MEDICAID PROVIDERS
Section 126-401 - Sanctions

Universal Citation: SC Code Regs 126-401

Current through Register Vol. 48, No. 9, September 27, 2024

A. The Administrator of the Title XFX Single State Agency may invoke one (1) or more of the following administrative sanctions against a Medicaid provider who has been determined to have abused the Medicaid Program:

(1) Educational Intervention;

(2) Postpayment Review of Claims;

(3) Prepayment Review of Claims;

(4) Referral to Licensing/Certifying Boards or Agencies;

(5) Peer Review;

(6) Suspension;

(7) Termination.

B. The Administrator of the Title XFX Single State Agency may invoke one (1) or more of the following administrative sanctions against a Medicaid provider who has been determined to be guilty of fraud or convicted of a crime related to his or her participation in Medicare or Medicaid, or for any reason for which the Secretary of the United States Department of Health and Human Services could exclude an individual or entity under 42 CFR §§ 1001 and 1003. [ 42 CFR § 1002.210] :

(1) Suspension;

(2) Termination;

(3) Exclusion.

Disclaimer: These regulations may not be the most recent version. South Carolina may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.