Bill > A03365

This bill amends the New York insurance law to reduce the lookback period for health insurance overpayment recovery from health care providers from twenty-four months to twelve months. Under the new legislation, health plans will be limited to initiating overpayment recovery efforts within twelve months after the original payment was received by a health care provider. However, this time limit does not apply in several specific circumstances, such as when there is a reasonable belief of fraud, intentional misconduct, abusive billing, or when the recovery is required by a self-insured plan or a government program. The bill also maintains a provision that allows health plans to defend against underpayment claims by referencing overpayments going back as far as the claimed underpayment. "Abusive billing" is defined as a billing practice that involves submitting claims inconsistent with sound fiscal, business, or medical practices, done with a frequency and duration that suggests a consistent pattern. The act will take effect thirty days after becoming law.

Business and Industry

https://www.nysenate.gov/legislation/bills/2025/A3365