S.C. Code Regs. § § 126-404

Current through Register Vol. 48, No. 10, October 25, 2024

Section 126-404 - Fair Hearings

A. Any Medicaid provider who has been notified in writing by the Single State Agency of a proposed recoupment of overpayments, a proposed exclusion, suspension or termination due to an administrative determination of abuse, or a proposed exclusion, suspension or termination due to a program related conviction in a state or federal court, may exercise his right to a fair hearing pursuant to R.126-150 prior to implementation of the proposed action. This subparagraph applies only to postpayment reviews of providers which are conducted by the Department. Further, this subparagraph shall not apply in the case of a provider who has been excluded, suspended or terminated from participation in the Medicare program, in which case the provisions of 42 CFR, Part 1001, shall apply.

B. Any individual Medicaid practitioner who has been convicted of a criminal offense related to his involvement in the Medicare or Medicaid Program and who is subsequently excluded, suspended or terminated pursuant to 42 CFR Section 402, Subpart C, may exercise his appeal rights as set forth in the written notice of exclusion, suspension or termination from the Centers for Medicare and Medicaid Services. Appeals to the Centers for Medicare and Medicaid Services shall be processed exclusively in accordance with 42 CFR Part 1005.

S.C. Code Regs. § 126-404

Amended by State Register Volume 20, Issue No. 6, Part 1, eff June 28, 1996; State Register Volume 42, Issue No. 05, eff. 5/25/2018.