Bill > S05209

This bill changes the existing insurance law to reduce the lookback period for insurance overpayment recovery from health care providers from twenty-four months to twelve months. Under the new provision, health plans will be prohibited from initiating overpayment recovery efforts more than twelve months after the original payment was received by a healthcare provider. However, important exceptions to this time limit remain in place, including cases involving suspected fraud, intentional misconduct, abusive billing, requests from self-insured plans, or requirements from state or federal government programs. The bill also maintains a provision that allows health plans to defend against underpayment claims by referencing overpayments going back in time as far as the claimed underpayment. The term "abusive billing" is specifically defined as a billing practice that submits claims inconsistent with sound fiscal, business, or medical practices, done with such frequency and duration as to reflect a consistent pattern of conduct. The bill will take effect thirty days after becoming law, potentially providing healthcare providers with more protection against lengthy retrospective payment reviews.

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https://www.nysenate.gov/legislation/bills/2025/S5209