Medicaid Provider and Recipient Fraud

2025-2026 Bill 915: Medicaid Provider and Recipient Fraud - South Carolina Legislature Online

South Carolina General Assembly
126th Session, 2025-2026
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This Bill
in Microsoft Word Format
Indicates Matter Stricken
Indicates New Matter
S. 915
STATUS INFORMATION
General Bill
Sponsors: Senators Garrett, Johnson, Adams, Bennett, Cash, Massey, Corbin, Turner, Blackmon, Kennedy, Stubbs, Reichenbach, Rice, Goldfinch, Elliott, Kimbrell, Alexander and Cromer
Document Path: SR-0116CEM26.docx
Introduced in the Senate on February 10, 2026
Introduced in the House on April 22, 2026
Last Amended on April 15, 2026

Currently residing in the House Committee on
Judiciary
Summary: Medicaid Provider and Recipient Fraud
HISTORY OF LEGISLATIVE ACTIONS

Date

Body

Action Description with journal page number

2/10/2026

Senate

Introduced and read first time (
Senate Journal-page 11
)

2/10/2026

Senate

Referred to Committee on
Medical Affairs
(
Senate Journal-page 11
)

2/18/2026

Senate

Recalled from Committee on
Medical Affairs
(
Senate Journal-page 4
)

2/18/2026

Senate

Committed to Committee on
Judiciary
(
Senate Journal-page 4
)

4/9/2026

Senate

Committee report: Favorable with amendment
Judiciary
(
Senate Journal-page 4
)

4/15/2026

Senate

Committee Amendment Adopted (
Senate Journal-page 72
)

4/15/2026

Senate

Read second time (
Senate Journal-page 72
)

4/15/2026

Senate

Roll call Ayes-45 Nays-0 (
Senate Journal-page 72
)

4/16/2026

Senate

Read third time and sent to House (
Senate Journal-page 12
)

4/22/2026

House

Introduced and read first time (
House Journal-page 16
)

4/22/2026

House

Referred to Committee on
Judiciary
(
House Journal-page 16
)

View the latest
legislative information
at the website
VERSIONS OF THIS BILL
02/10/2026
04/09/2026
04/15/2026

Indicates Matter Stricken

Indicates New Matter

Committee Amendment Adopted

April 15, 2026

S. 915

Introduced by Senators Garrett, Johnson, Adams,
Bennett, Cash, Massey, Corbin, Turner, Blackmon, Kennedy, Stubbs, Reichenbach,
Rice, Goldfinch, Elliott, Kimbrell, Alexander and Cromer

S. Printed 4/15/26--S.

Read the first time February 10, 2026

________

A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING
SECTION
43-7-60
, RELATING TO THE PROHIBITION OF FALSE CLAIMS, STATEMENTS, OR
REPRESENTATION BY MEDICAL PROVIDERS, SO AS TO CREATE TIERED VIOLATIONS AND
PENALTIES FOR THIS SECTION AND PROVIDE FOR THE USE OF CONSENT AGREEMENTS; BY
AMENDING SECTION
43-7-70
, RELATING TO THE PROHIBITION OF FALSE STATEMENTS OR
REPRESENTATION ON APPLICATIONS FOR ASSISTANCE, SO AS TO CREATE TIERED
VIOLATIONS AND PENALTIES FOR THIS SECTION AND PROVIDE FOR THE USE OF CONSENT AGREEMENTS;
AND BY AMENDING SECTION
43-7-90
, RELATING TO THE ENFORCEMENT OF SECTIONS
43-7-60
TO
43-7-80
, SO AS TO AUTHORIZE THE ATTORNEY GENERAL TO ISSUE
ADMINISTRATIVE SUBPOENAS AND OTHER APPROPRIATE ACTIONS.

Amend Title To Conform

B
e it enacted by the
General Assembly of the State of South Carolina:

S
ECTION 1.
S
ection
43-7-60
of the S.C. Code is amended to read:

S
ection
43-7-60
.
(
A) For purposes of this
section:

(
1)
"
provider" includes
Provider"
means
a person who provides goods, services, or assistance and who is
entitled or claims to be entitled to receive reimbursement, payment, or
benefits under the
state's
State

Medicaid
program
Program
.
"Provider" also includes
an owner, a billing agent, and

a person acting as an employee, representative, or agent of the provider.

(
2)
"
false
False
claim,
statement, or representation" means a claim, statement, or representation made
or presented
, or attempted to be made or presented,

in any form including, but not limited to, a claim, statement, or
representation which is computer generated or transmitted or made, produced, or
transmitted by an electronic means or device.

(
3) "State Medicaid Program" means the
state or federal agency which administers or assists in the administration of
the State Medicaid Program, a Managed Care Organization, or similar entity
contracted under the State Medicaid Program to provide goods, services, or
assistance.

(
B) It
is unlawful for a provider of medical assistance, goods, or services to
knowingly and wilfully make or cause to be made a false claim, statement, or
representation of a material fact:

(
1)
in an application or request, including an electronic or computer generated
claim, for a benefit, payment, or reimbursement from
the
State Medicaid Program
a state or federal agency
which administers or assists in the administration of the state's medical
assistance or Medicaid program
; or

(
2)
on a report, certificate, or similar document, including an electronic or
computer generated claim, submitted to
a state or federal
agency which administers or assists in the administration of the state's
the State
Medicaid
Program
program
in order for a provider or facility to qualify or
remain qualified under the
state's
State
Medicaid
Program
program
to provide assistance, goods, or services, or
receive reimbursement, payment, or benefit for this assistance, goods, or
services.

For purposes of this
subsection, each false claim, representation, or statement constitutes a
separate offense.

(
C) It
is unlawful for a provider of medical assistance, goods, or services knowingly
and wilfully to conceal or fail to disclose any material fact, event, or
transaction which affects the:

(
1)
provider's initial or continued entitlement to payment, reimbursement, or
benefits under the
state's
State

Medicaid
plan
Program
;

or

(
2)
amount of payment, reimbursement, or benefit to which the provider may be
entitled for services, goods, or assistance rendered.

For purposes of this
subsection, each fact, event, or transaction concealed or not disclosed
constitutes a separate offense.

(
D)

A person who violates the provisions of
this section
subsection (B) or
subsection (C), or a person who knowingly aids, assists, abets, solicits, or
conspires with another person to violate the provisions of subsection (B) or
subsection (C),
is guilty of
medical assistance
provider fraud,
a
:

Class
A misdemeanor and, upon conviction, must be imprisoned not more than three
years and fined not more than one thousand dollars for each offense.

(
1) misdemeanor if the amount of the
economic advantage or benefit sought or received is less than five thousand
dollars. Upon conviction, the person must be imprisoned not more than three
years or fined not more than one thousand dollars, or both;

(
2) felony if the amount of the economic
advantage or benefit sought or received is five thousand dollars or more but
less than fifty thousand dollars. Upon conviction, the person must be fined not
less than five thousand nor more than twenty thousand dollars or imprisoned not
more than five years, or both; or

(
3) felony if the amount of the economic
advantage or benefit sought or received is fifty thousand dollars or more. Upon
conviction, the person must be fined not less than twenty thousand nor more
than fifty thousand dollars or imprisoned not more than ten years, or both.

(
E) In addition to the criminal
penalties set forth in subsection (D), a person convicted pursuant to the
provisions of this section must be ordered by the court to make full
restitution to a victim for any economic advantage or benefit that has been
obtained by the person as a result of that violation.

(E)
(
F)
In addition to all other remedies provided by law, the
Attorney General may bring an action to recover damages equal to three times
the amount of an overstatement or overpayment and the court may impose a civil
penalty of two thousand dollars for each false claim, representation, or
overstatement made to a state or federal agency which administers funds under
the state's Medicaid program. Upon a finding that the provider has violated a
provision of this section, the state agency which administers the Medicaid
program may impose other administrative sanctions against the provider
authorized by law. A civil or criminal action brought under this section may
be filed or brought in either the county where the
false
claim, statement, or representation
violation
originated
,
or in the county in which the

false claim, statement, or representation
violation

was received by the
Health and Human Services
Finance Commission
Department of Health and Human
Services
or other agency of the State responsible for administering the
state's Medicaid Program.

(
G) Nothing in this section shall be
construed to prohibit the Attorney General and the person alleged to be guilty
of a violation of this section from entering into a written agreement in which
the person does not admit or deny the charges but consents to payment of the
civil penalty or appropriate voluntary restitution amount, or both. A consent
agreement may not be used in a subsequent civil or criminal proceeding relating
to any violation of this article.

S
ECTION 2.
S
ection
43-7-70
of the S.C. Code is amended to read:

S
ection
43-7-70
.
(
A)(1) It is unlawful for a
person to knowingly and wilfully to make or cause to be made a false statement
or representation of material fact on an application for assistance, goods, or
services under the
state's
State

Medicaid
Program
program

when the false statement or representation is made for the purpose of
determining the person's entitlement to assistance, goods, or services.

(
2)
It is unlawful for any applicant, recipient, or other person acting on behalf
of the applicant or recipient
to
knowingly and
wilfully to conceal or fail to disclose any material fact affecting the
applicant's or recipient's initial or continued entitlement to receive
assistance, goods, or services under the
state's
State
Medicaid
program
Program
.

(
3)
It is unlawful for a person eligible to receive benefits, services, or goods
under the
State
Medicaid
program
Program
to sell, lease, lend, or otherwise exchange
rights, privileges, or benefits to another person.

(
B)
A person who violates subsection (A), or a person who knowingly aids,
assists, abets, solicits, or conspires with another person to violate subsection
(A), is guilty of a:
A person who violates the
provisions of this section is guilty of medical assistance recipient fraud, a
Class A misdemeanor and, upon conviction, must be imprisoned not more than
three years or fined not more than one thousand dollars, or both.

(
1) misdemeanor if the amount of the
economic advantage or benefit sought or received is less than five thousand
dollars. Upon conviction, the person must be imprisoned not more than three
years or fined not more than one thousand dollars, or both;

(
2) felony if the amount of the economic
advantage or benefit received is five thousand dollars or more but less than
fifty thousand dollars. Upon conviction, the person must be fined not less than
five thousand nor more than twenty thousand dollars or imprisoned not more than
five years, or both; or

(
3) felony if the amount of the economic
advantage or benefit received is fifty thousand dollars or more. Upon
conviction, the person must be fined not less than twenty thousand nor more
than fifty thousand dollars or imprisoned not more than ten years, or both.

(
C) In addition to the criminal
penalties set forth in subsection (B), a person convicted pursuant to the
provisions of this section must be ordered by the court to make full
restitution to a victim for any economic advantage or benefit that has been
obtained by the person as a result of that violation.

(
D) In addition to all other remedies
under this section, the Attorney General may bring a civil action to recover
damages equal to three times the amount of the overpayment by the state agency that
administers funds under the State Medicaid Program. A civil or criminal action
brought under this section may be filed or brought in either the county where
the violation originated, or in the county in which the violation was received
by the Department of Health and Human Services or other agency of the State responsible
for administering the State Medicaid Program.

(
E) In addition to any criminal
liability, any person who is found by a court of competent jurisdiction to have
violated any provision of this section is subject to a civil penalty for each
violation as follows:

(
1) for a first offense, a fine not to
exceed five thousand dollars;

(
2) for a second offense, a fine of not
less than five thousand dollars but not to exceed twenty thousand dollars; or

(
3) for a third and subsequent offense,
a fine of not less than twenty thousand dollars but not to exceed fifty
thousand dollars.

(
F) Nothing in this section shall be
construed to prohibit the Attorney General and the person alleged to be guilty
of a violation of this section from entering into a written agreement in which
the person does not admit or deny the charges but consents to payment of the
civil penalty or appropriate voluntary restitution amount, or both. A consent
agreement may not be used in a subsequent civil or criminal proceeding relating
to any violation of this article.

S
ECTION 3.
S
ection
43-7-90
of the S.C. Code is amended to read:

S
ection
43-7-90
.
T
he Attorney General has the authority and
responsibility to investigate and initiate appropriate action for alleged or
suspected violations of Sections
43-7-60
through
43-7-80
.

This includes, but is not limited to:

(
1) issue administrative subpoenas for
the purpose of gathering information and documents relevant to investigating
fraud involving the State Medicaid Program; and

(
2) institute proceedings in a court of
competent jurisdiction to seek relief necessary to carry out the provisions of
this article.

S
ECTION 4. This act takes effect upon approval
by the Governor.

----XX----

This web page was last updated on April 15, 2026 at 5:48 PM