South Carolina § 38-71-1830 Recoupment.

South Carolina Statutes

§ 38-71-1830 — Recoupment.

South Carolina·Title 38 INSURANCE·Ch. 71 ACCIDENT AND HEALTH INSURANCE

(A)Recoupments of any funds disputed on the basis of an audit must occur only after final internal disposition of the audit, including the appeals process as provided for in Section 38-71-1820 or the external review pursuant to Section 38-71-2240, unless fraud or misrepresentation is reasonably suspected.

(B)Recoupment on an audit must be refunded to the responsible party as contractually agreed upon by the parties involved in the audit.

(C)The entity conducting the audit may charge or assess the responsible party, directly or indirectly, based on amounts recouped if both of the following conditions are met:

(1)the responsible party or payor and the entity conducting the audit have entered into a contract that explicitly states the percentage charge or assessment to the responsible par

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(A) Recoupments of any funds disputed on the basis of an audit must occur only after final internal disposition of the audit, including the appeals process as provided for in Section 38-71-1820 or the external review pursuant to Section 38-71-2240, unless fraud or misrepresentation is reasonably suspected. (B) Recoupment on an audit must be refunded to the responsible party as contractually agreed upon by the parties involved in the audit. (C) The entity conducting the audit may charge or assess the responsible party, directly or indirectly, based on amounts recouped if both of the following conditions are met: (1) the responsible party or payor and the entity conducting the audit have entered into a contract that explicitly states the percentage charge or assessment to the responsible party; and (2) a commission or other payment to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped.

South Carolina § 38-71-1830 (Recoupment.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

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, in (A), inserted "or the external review pursuant to Section 38-71-2240".