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HS1FORHB212 • 2025

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor
Last action
2025-09-03
Official status
Signed by Governor
Effective date
Not listed

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.

What This Bill Does

  • AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.
  • This Substitute for House Bill No.
  • 212 corrects a technical drafting error to underline new language contained in Section 2 of the Act, and is otherwise identical to House Bill No.
  • 212, which does the following: Section 1 of this Act amends the time period during which health insurers may initiate overpayment recovery efforts from 24 months to 12 months of a claim being paid.

Limits and Unknowns

  • This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Bill History

  1. 2025-09-03 Delaware General Assembly

    Signed by Governor

  2. 2025-06-30 Delaware General Assembly

    Passed By Senate. Votes: 21 YES

  3. 2025-06-25 Delaware General Assembly

    Reported Out of Committee (Banking, Business, Insurance & Technology) in Senate with 7 On Its Merits

  4. 2025-06-24 Delaware General Assembly

    Passed By House. Votes: 40 YES 1 VACANT

  5. 2025-06-24 Delaware General Assembly

    Assigned to Banking, Business, Insurance & Technology Committee in Senate

  6. 2025-06-18 Delaware General Assembly

    was introduced and adopted in lieu of HB 212

Official Summary Text

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.
This Substitute for House Bill No. 212 corrects a technical drafting error to underline new language contained in Section 2 of the Act, and is otherwise identical to House Bill No. 212, which does the following:

Section 1 of this Act amends the time period during which health insurers may initiate overpayment recovery efforts from 24 months to 12 months of a claim being paid. This Act also amends one of the exemptions to the overpayment recovery deadline to require an indication of fraud, abuse, or other intentional misconduct based on a physical review or review of claims data or statements as opposed to merely having a reasonable belief of such fraud, abuse or other intentional misconduct. It aligns requirements for provider-oriented clawbacks with those for pharmacies.

Section 2 of this Act requires written notice from pharmacy benefit managers or entities conducting pharmacy audits. Because Department examinations have indicated that PBMs misuse this provision in the law to