South Carolina              
Administrative Law Court
Edgar A. Brown building 1205 Pendleton St., Suite 224 Columbia, SC 29201 Voice: (803) 734-0550

SC Administrative Law Court Decisions

CAPTION:
Mariah Riley vs. Self Regional Healthcare

AGENCY:
Self Regional Healthcare

PARTIES:
Petitioner:
Mariah Riley

Respondent:
Self Regional Healthcare
 
DOCKET NUMBER:
05-ALJ-30-0107-CC

APPEARANCES:
n/a
 

ORDERS:

FINAL ORDER AND DECISION

I. Introduction

 

Mariah Riley (Riley) challenges the setoff of her South Carolina Income Tax Refund by the South Carolina Department of Revenue due to a request for such a set-off by Self Regional Healthcare (Self). Self obtained the setoff under the Setoff Debt Collection Act by asserting that Riley was indebted to Self for medical services rendered.

II. Issue

 

In the broadest sense, the issue here is whether the debt setoff was proper.

 

III. Analysis

 

A. Findings of Fact

 

Based on the preponderance of the evidence, the following findings of fact are entered:

 

Riley received services at Self on two occasions. The first involved a mammogram and the second a bone scan of one of Riley’s fingers. The rendering of these services generated two debts owed by Riley with the debts evidenced by charges to accounts # A0304800333 in the amount of $116.66 and account # A0331000180 in the amount of $582.25 for a total of $698.91.

 

Prior to receiving the services, Riley signed forms acknowledging that she understood that receiving the services would make her liable for the charges. Further, and again prior to receiving the services, Riley provided Self with documentation of her health insurance. She provided the insurance information with the intent having the services rendered by Self paid for by her health insurance provider.

 

Neither Riley’s primary care physician nor her insurance provider granted authorization for the services prior to the services being rendered. As a result, in each case, the insurance provider did not make payment for the services and explained that the lack of payment was due to the fact the services were “not authorized in advance by [Riley’s] primary care physician or CHC [Companion Health Care].” When receiving information on a patient presenting herself for services, Self does not seek pre-approval from the patient’s insurance provider. Rather, Self leaves that responsibility with the patient.

 

After the debt remained unpaid, Self utilized the Debt Set‑Off Collection Act to allow DOR to deduct the amount of the debts plus costs of $50.00 in administrative fees from Riley’s income tax refund. Riley has now brought this action seeking to have her refund returned.

 

B. Conclusions of Law

 

Based on the foregoing Findings of Fact, I conclude the following as a matter of law:

 

Pursuant to Act 1554 of 1968, Self is a public institution of Greenwood County, a political subdivision of the State of South Carolina. Accordingly, Self is a “claimant agency” entitled to utilize the Debt Set‑Off Collection Act. S.C. Code Ann. §12-56-20(1) (“Claimant agency" means a state agency, board, committee, commission, public institution of higher learning, political subdivision, or other governmental or quasi-governmental entity of any state or the United States.”).

 

Nothing in this case shows any error of procedure in Self’s submittal of its claims for $698.91 to the Department of Revenue for set-off against Riley’s income tax refund. Rather, the argument presented by Riley is that no debt is due since Self had an obligation to seek pre-approval of the services before the services were rendered. I cannot agree.

 

Here, the evidence shows that Riley signed forms acknowledging that she was responsible for the payment of the services provided. Thus, before the services were rendered, both Self and Riley understood that payment for the services ultimately belonged to Riley.

 

Further, Self’s witnesses established that Self does not assume the responsibility of obtaining pre-approval of any services provided by the hospital. Rather, Self leaves that responsibility with the patient. Accordingly, before the insurance provider become obligated to provide coverage, the patient must satisfy the terms of the insurance coverage. Here, the services were rendered, no pre-approval was obtained, and Riley remains liable for the debt.

 



 

 

IV. Order

 

Based upon the Findings of Fact and Conclusions of Law, it is hereby ordered:

 

Mariah Riley’s challenge to the setoff of her South Carolina Income Tax Refund by the South Carolina Department of Revenue due to a request for such a set-off by Self Regional Healthcare is DENIED.

 

AND IT IS SO ORDERED.

 

 

 

_________________________________

RAY N. STEVENS

Administrative Law Judge

 

Dated: August 22, 2005

Columbia, South Carolina


Brown Bldg.

 

 

 

 

 

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