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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)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 1 costs, 0 mixed.

Insurer clawbacks capped at 12 months

Health insurers and health plans cannot start overpayment recovery more than 12 months after the original payment date. "Start" means the first time they find an error and tell the provider, like in an initial audit report. The 12‑month limit does not apply if fraud, abuse, or other intentional misconduct is indicated by a physical review or claims data or statements. It also does not apply if a self‑insured plan requires or requests recovery, or if a state or federal government plan requires it.

Pharmacies and providers: no extrapolation, notice

Auditors must base findings on actual overpayments, not projections from a sample. They cannot use extrapolation to set recoupments or penalties unless state or federal law or rules require it. When a pharmacy benefit manager seeks a recoupment or chargeback, it must send written notice. The notice must name the exact error and explain why the money is being taken.

Wider audit powers in fraud cases

The usual limits on pharmacy audits do not apply in investigative audits when fraud, waste, abuse, or other intentional misconduct is indicated by physical review or by claims data or statements. They also do not apply if other investigative methods show criminal wrongdoing or willful misrepresentation. The limits do not apply when the State conducts the audit. Investigators have broader authority in these cases.

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

    HTML

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