South Carolina S 915: Medicaid Provider and Recipient Fraud

Bill Text

2025-2026 Bill 915 Text of Previous Version (Apr. 15, 2026) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 915

Indicates Matter Stricken
Indicates New Matter

(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

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

Be it enacted by the 
General Assembly of the State of South Carolina:

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

 Section 
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'sState 
Medicaid programProgram. 
"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 Programa 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 Programprogram in order for a provider or facility to qualify or 
remain qualified under the state'sState Medicaid Programprogram 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'sState 
Medicaid planProgram; 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