South Carolina Code of Laws
Chapter 33 - Health Maintenance Organizations
Section 38-33-170. Examination of affairs of organization; quality of health care services; books and records; expense of examination; reports.

(A) The director or his designee may make an examination of the affairs of a health maintenance organization and providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State but not less frequently than once every five years. The director or his designee may accept the report of an examination made by the state where the health maintenance organization is domiciled.
(B) The director or his designee may make an examination concerning the quality of health care service of a health maintenance organization and providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State but not less frequently than once every five years.
(C) Every health maintenance organization and provider shall submit its relevant books and records for the examinations and facilitate them. For the purpose of examinations, the director or his designee and the department may administer oaths to and examine the officers and agents of the health maintenance organization and the principals of the providers concerning their business.
(D) The expenses of examinations under this section are assessed against the organization being examined and remitted to the director or his designee for whom the examination is being conducted.
HISTORY: Enacted as 1976 Code Section 38-25-170 by 1987 Act No. 83, Section 1; recodified as Section 38-33-170 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 5; 1993 Act No. 181, Section 633; 2018 Act No. 219 (H.4657), Section 3, eff May 18, 2018.
Effect of Amendment
2018 Act No. 219, Section 3, in (A), in the first sentence, substituted "five years" for "three years"; and in (B), substituted "five years" for "three years".

Structure South Carolina Code of Laws

South Carolina Code of Laws

Title 38 - Insurance

Chapter 33 - Health Maintenance Organizations

Section 38-33-10. Short title.

Section 38-33-20. Definitions.

Section 38-33-30. Necessity of certificate of authority; foreign corporation.

Section 38-33-40. Issuance of certificate of authority; criteria and considerations; arrangements for participation of providers in each geographic area served.

Section 38-33-50. Powers of health maintenance organization; notice prior to exercise of powers.

Section 38-33-60. Members of governing body; advisory panels, etc.

Section 38-33-70. Fiduciary relationship in handling of funds.

Section 38-33-80. Enrollee entitled to evidence of coverage; contents of evidence of coverage; discontinuance or replacement of coverage; charges for services.

Section 38-33-90. Statements and reports.

Section 38-33-100. Financial requirements before issuance of certificate of authority to health maintenance organization.

Section 38-33-110. Complaint procedures; reports; malpractice claims; applicability of Freedom of Information Act.

Section 38-33-120. Investment of funds.

Section 38-33-130. Security deposit; individual stop-loss coverage; provisions for unpaid claim liability; individual conversion policy.

Section 38-33-140. Advertisements; application of provisions relating to trade practices; use of term "insurer" or "health maintenance organization".

Section 38-33-150. Agent for organization; exemption from licensing requirements.

Section 38-33-160. Operation of health maintenance organization by insurance company; contracts for cost of care.

Section 38-33-170. Examination of affairs of organization; quality of health care services; books and records; expense of examination; reports.

Section 38-33-180. Suspension or revocation of certificate of authority.

Section 38-33-190. Rehabilitation, liquidation, or conservation of a health maintenance organization; priorities.

Section 38-33-200. Implementation of regulations.

Section 38-33-210. Notification of grounds for denial, suspension or revocation of certificate of authority; hearings; judicial review.

Section 38-33-220. Fees.

Section 38-33-230. Levy of administrative penalty in lieu of revocation or suspension of certificate of authority; monetary penalty; notice and hearings; injunctions.

Section 38-33-240. Application of provisions of insurance law or law relating to solicitation or advertising by health professionals; practice of medicine, dentistry or other healing profession.

Section 38-33-250. Records of organization as public documents; trade secrets, etc.

Section 38-33-260. Confidentiality of health records.

Section 38-33-270. Contractual powers of Department to assist in investigative duties; assessments for consulting expenses.

Section 38-33-280. Acquisition or exchange of securities of a health maintenance organization; merger or consolidation of HMO.

Section 38-33-290. Participation by physician, podiatrist, optometrist, or oral surgeon as provided in HMO.

Section 38-33-300. Liability for participation in quality of care or utilization review.

Section 38-33-310. HMO may contract with out-of-state provider.

Section 38-33-325. Obstetrician-gynecologist services; referrals; authorization for services; member notification of plan provisions.