§ 44-113-10 Short title
§ 44-113-20 Definitions
§ 44-113-30 Health care provider not to refer patient to entity in which it has investment interest; exceptions; violations; penalties
§ 44-113-40 When provider may refer patient to entity in which it has investment interest; signed disclosure required
§ 44-113-50 Report to department of results of action taken by boards
§ 44-113-60 Kickback defined; penalty
§ 44-113-70 Employers providing health insurance benefits to employees may report over-utilization of services to Department of Insurance
§ 44-113-80 Person permitted to make referral to entity in which he has interest must submit certain information to department

Terms Used In South Carolina Code > Title 44 > Chapter 113 - Provider Self-Referral

  • Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Board: means any of the boards created pursuant to Title 40, as amended, to license, certify, or register health care professionals. See South Carolina Code 44-113-20
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Department: means the South Carolina Department of Health and Environmental Control. See South Carolina Code 44-113-20
  • Designated health services: means any health care procedure, service, or item provided by a health care provider. See South Carolina Code 44-113-20
  • Entity: means an individual, partnership, firm, corporation, or other business entity. See South Carolina Code 44-113-20
  • Group practice: means a group of two or more health care professionals legally organized as a partnership, professional corporation, not-for-profit corporation, faculty practice plan, or similar association in which:

    (a) each health care professional who is a member, employee, or independent contractor of the group provides substantially the full range of services which the professional routinely provides including consultation, diagnosis, and treatment through the use of office space, facilities, equipment, and personnel of the group;

    (b) substantially all of the services of the health care professionals who are members of the group are provided through the group and are billed in the name of the group and amounts so received are treated as receipts of the group; and

    (c) the overhead expenses of and the income from the practice are distributed by methods previously determined by the group. See South Carolina Code 44-113-20
  • Health care facility: means a health care facility as defined in § 44-7-130(10). See South Carolina Code 44-113-20
  • health care professional: means a person licensed, certified, or registered under the laws of this State to provide health care services. See South Carolina Code 44-113-20
  • Immediate family member: means a health care provider's spouse, child, child's spouse, grandchild, grandchild's spouse, parent, parent-in-law, or sibling. See South Carolina Code 44-113-20
  • Investment interest: means an equity or debt security issued by an entity including, except as provided below, but not limited to, shares of stock in a corporation, units or other interests in a partnership, bonds, debentures, notes, other equity interests, or debt instruments. See South Carolina Code 44-113-20
  • Investor: means a person or entity owning a legal or beneficial ownership or investment interest, directly or indirectly including, but not limited to, through an immediate family member, trust, or corporation, the stock of which is owned in whole or in part by the investor or another entity related to the investor. See South Carolina Code 44-113-20
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Referral: means a referral of a patient by a health care provider for health care services including, but not limited to:

    (a) the forwarding of a patient by a health care provider to another health care provider or to an entity outside the health care professional's office or group practice which provides or supplies designated health services or any other health care item or service; or

    (b) the request or establishment of a plan of care by a health care provider, which includes the provision of a designated health service or any other health care item or service outside the health care professional's office or group practice. See South Carolina Code 44-113-20
  • Rural area: means a county with a population of one hundred thousand persons or less according to the latest United States census. See South Carolina Code 44-113-20