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DelawareHB 212153rd General Assembly (2024–2026)HouseWALLET

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

Sponsored By: William Bush (Democratic)

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 1 costs, 0 mixed.

Pharmacies get written payment recovery notices

Pharmacy benefit managers must give pharmacies written notice when seeking money back through a recovery or chargeback. The notice must identify the error in processing or paying the claim. It must also explain why the recovery or chargeback is justified.

Providers protected from projected overpayment claims

Health insurers and plans must base overpayment findings on actual overpayments, not projections. They cannot project overpayments from patient counts, similar diagnoses, or similar drug orders or refills. Auditors also cannot calculate money to recover or penalties by projecting findings from some claims onto others. That calculation method is allowed only when state or federal law or regulations require it.

Shorter deadline for reclaiming provider payments

Health insurers and plans generally have 12 months after paying a claim to start recovering overpayments, down from 24 months. Recovery starts when an initial audit report or similar notice identifies the error to the provider. The deadline does not apply to recoveries requested or required by self-insured plans, or required by state or federal government plans. It also excludes fraud, abuse, or intentional misconduct indicated by physical review or review of claims data or statements. A reasonable belief alone is not enough for the misconduct exception.

Some pharmacy investigations bypass audit protections

The pharmacy audit subchapter does not cover specified investigations of pharmacy records. This applies when physical review or review of claims data or statements indicates fraud, waste, abuse, or intentional misconduct. It also applies when other investigative methods indicate criminal wrongdoing, fraud, or intentional or willful misrepresentation. Investigative audits conducted by the State are also excluded. Pharmacies facing these audits do not receive that subchapter's protections.

Sponsors & Cosponsors

Sponsor

  • William Bush

    Democratic • House

Cosponsors

  • Stephanie T. Bolden

    Democratic • House

  • Spiros Mantzavinos

    Democratic • Senate

  • Nicole Poore

    Democratic • Senate

  • Bryan Townsend

    Democratic • Senate

  • David L. Wilson

    Republican • Senate

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. HS 1 for HB 212 - Signed by Governor

    9/3/2025Governor

  2. HS 1 for HB 212 - Passed By Senate. Votes: 21 YES

    6/30/2025Senate

  3. HS 1 for HB 212 - Reported Out of Committee (Banking, Business, Insurance & Technology) in Senate with 7 On Its Merits

    6/25/2025Senate

  4. HS 1 for HB 212 - Assigned to Banking, Business, Insurance & Technology Committee in Senate

    6/24/2025Senate

  5. HS 1 for HB 212 - Passed By House. Votes: 40 YES 1 VACANT

    6/24/2025House

  6. Substituted in House by HS 1 for HB 212

    6/18/2025House

  7. Reported Out of Committee (Economic Development/Banking/Insurance & Commerce) in House with 2 Favorable, 9 On Its Merits

    6/17/2025House

  8. Introduced and Assigned to Economic Development/Banking/Insurance & Commerce Committee in House

    6/10/2025House

Bill Text

  • Current

    6/10/2025

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