South Carolina § 38-71-1840 - Exemptions.

§ 38-71-1840. Exemptions.

The provisions of this article do not apply to an audit, review, or investigation:

(1) that involves alleged insurance fraud or abuse, Medicare fraud or abuse, or other fraud or misrepresentation;

(2) conducted by or on the behalf of the Department of Health and Human Services in the performance of its duties in administering Medicaid under Titles XIX and XXI of the Social Security Act; or

(3) notwithstanding the exemptions under subsections (1) and (2) of this section, contracts between the South Carolina Department of Health and Human Services and Medicaid-managed care organizations must include provisions for biannual audits of Medicaid-managed care organizations' pharmacy pricing and include limitations on any pharmacy benefits manager contract arrangements that bill the Medicaid program for more than the total price paid to pharmacies for actual claims.

HISTORY: 2012 Act No. 250, SECTION 1, eff January 1, 2013; 2023 Act No. 30 (S.520), SECTION 1, eff January 1, 2024.

Editor's Note

2023 Act No. 30, SECTION 7, provides as follows:

"SECTION 7. This act takes effect January 1, 2024, but the recurring examinations by the Department of Insurance provided for in Sections 38-71-2250(B)(1) and 38-71-2340(B)(1) must not begin before January 1, 2025."

Effect of Amendment

2023 Act No. 30, SECTION 1, added (3) and made nonsubstantive changes.