S.C. Code Regs. § § 19-1040

Current through Register Vol. 48, No. 11, November 22, 2024

Section 19-1040 - Penalties for Failure to Meet Timeliness, Completion and Accuracy Requirements

A. Pursuant to South Carolina Code Section 44-6-170 G, the Office may assess a civil fine for failure to comply with these regulations.

B. Failure to provide one record for each patient encounter according to these regulations or meet accuracy and item-completeness standards set forth in these regulations:

(1) First occurrence: the Office of Research and Statistics shall notify the health care provider by certified letter of failure to comply. The health care provider shall reply in writing as to the reasons for non-compliance and provide a summary of measures implemented to insure future compliance. Full compliance shall occur within two subsequent monthly submissions;

(2) Subsequent occurrences: fines may be followed as in subsection C (2) below.

C. Failure to meet time frames for submission of required medical record extract information:

(1) The Office of Research and Statistics shall notify the health care provider by certified letter of failure to comply. The health care provider shall be granted a two-week grace period beginning on the date of the receipt of the letter.

(2) If the health care provider fails to comply within the grace period:

(a) The Office of Research and Statistics shall notify the health care provider by certified letter of failure to comply. The health care provider shall respond in writing to the Office of Research and Statistics within one week of date of receipt as to reasons for non-compliance.

(b) The Office of Research and Statistics may extend the grace period if it deems it warranted (as demonstrated by a good faith effort on the part of the health care provider), and shall notify the health care provider in writing.

(c) Health care providers covered by these regulations failing to comply within the grace period(s) may be fined as follows and the total fine may not exceed ten thousand dollars:

(i) First occurrence $ 100

(ii) Second occurrence $1,000

(iii) Third occurrence $5,000

A six-month grace period from the date these regulations become effective shall be granted by the Office of Research and Statistics before these regulations are enforced.

The fines as levied in C (2)(c) above shall be reset to "first occurrence" levels beginning three years from the date of first occurrence, or upon change of ownership of the health care provider, or upon change of the chief executive officer.

D. The proposed penalties become the final agency decision within ten days after the certified letter to the administrator unless the health care provider requests a reconsideration of the penalty in writing within the ten day grace period from the Executive Director of the Budget and Control Board or his/her designee. When such a request is submitted:

(1) The burden of proof for contested penalties will be upon the health care provider; and

(2) The Executive Director of the Budget and Control Board or his/her designee must respond by certified letter to the health care provider's request within thirty days from the receipt of the request.

S.C. Code Regs. § 19-1040

Added by State Register Volume 19, Issue No. 7, eff July 28, 1995. Amended by State Register Volume 22, Issue No. 6, Part 3, eff July 26, 1998; State Register Volume 29, Issue No. 6, eff June 24, 2005; State Register Volume 32,, Issue No. 6, eff June 27, 2008.