Current Status Introducing Body:Senate Bill Number:1302 Primary Sponsor:Mitchell Committee Number:02 Type of Legislation:GB Subject:Fraudulent Insurance Claims Act Residing Body:Senate Current Committee:Banking and Insurance Computer Document Number:BBM/9060JM.94 Introduced Date:19940329 Last History Body:Senate Last History Date:19940329 Last History Type:Introduced, read first time, referred to Committee Scope of Legislation:Statewide All Sponsors:Mitchell Type of Legislation:General Bill
Bill Body Date Action Description CMN Leg Involved
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1302 Senate 19940329 Introduced, read first time, 02
referred to Committee
View additional legislative information at the LPITS web site.
TO ENACT THE "FRAUDULENT INSURANCE CLAIMS ACT", INCLUDING PROVISIONS FOR CRIMINAL OFFENSES AND PENALTIES.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. This act is known and may be cited as the "Fraudulent Insurance Claims Act".
SECTION 2. Any person who knowingly or wilfully files a false health insurance claim with an insurer, health service corporation, or health maintenance organization by engaging in any one or more of the following false billing practices commits the crime of insurance fraud:
(1) "unbundling" a health insurance claim by claiming a number of medical procedures were performed instead of a single comprehensive procedure;
(2) "upcoding" a health insurance claim by claiming that a more serious or extensive procedure was performed than was actually performed; or
(3) "exploding" a health insurance claim by claiming a series of tests were performed on a single sample of blood, urine, or other bodily fluid when actually the series of tests were part of one battery of tests.
SECTION 3. Nothing in this act prohibits providers from making good faith efforts to ensure that claims for reimbursement are coded to reflect a proper diagnosis and treatment.
SECTION 4. Violation of this act is punishable as follows:
(1) as a felony if the result of the additional amount claimed exceeds $1,000.00, and the violator must be punished by a fine not to exceed $15,000.00 or by imprisonment not to exceed ten years, or by both such fine and imprisonment;
(2) as a felony if the result of the additional amount claimed exceeds $250.00 but does not exceed $1,000.00, and the violator must be punished by a fine not to exceed $10,000.00 or by imprisonment not to exceed five years, or by both such fine and imprisonment;
(3) as a misdemeanor if the result of the additional amount claimed exceeds $100.00 but does not exceed $250.00, and the violator must be punished by a fine not to exceed $5,000.00 or by imprisonment not to exceed three years, or by both such fine and imprisonment;
(4) as a misdemeanor if the result of the additional amount claimed does not exceed $100.00, and the violator must be punished by a fine not to exceed $1,000.00 or by imprisonment not to exceed two years, or by both such fine and imprisonment.
SECTION 5. This act takes effect upon approval by the Governor.