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DelawareHS 1 for HB 212153rd General Assembly (2024–2026)House

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

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

Stronger audit protections for pharmacies

Pharmacy benefit managers and pharmacy auditors seeking money back must give pharmacies written notice explaining the claim-processing or payment error. The notice must also explain why they are seeking repayment or a chargeback. Pharmacy audit protections apply to more investigative audits, with specific exclusions. They exclude audits when physical review, claims data, or statements indicate fraud, waste, abuse, or intentional or willful misconduct. They also exclude audits when other investigative methods indicate criminal wrongdoing, fraud, or intentional or willful misrepresentation by a pharmacy. State-conducted investigative audits are excluded too.

Stronger repayment protections for health-care providers

Health insurers and health plans have 12 months after the original claim payment to start recovery, down from 24 months. Recovery starts when an initial audit report or similar message identifying the payment error reaches the provider. The deadline excludes recovery based on fraud, abuse, or intentional misconduct indicated by physical review, claims data, or statements. It also excludes recovery required or requested by self-insured plans, or required by state or federal government plans. Audit findings must reflect actual overpayments, not projections from patients with similar diagnoses or similar drug orders or refills. Auditors cannot project amounts to calculate repayments or penalties unless state or federal law or regulations require it.

Sponsors & Cosponsors

Sponsor

  • William Bush

    Democratic • House

Cosponsors

  • Stephanie T. Bolden

    Democratic • House

  • Larry Lambert

    Democratic • House

  • Spiros Mantzavinos

    Democratic • Senate

  • Nicole Poore

    Democratic • Senate

  • Claire Snyder-Hall

    Democratic • House

  • Bryan Townsend

    Democratic • Senate

  • David L. Wilson

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 61 • No: 0

Senate vote • 6/30/2025

Passed (SM required)

Yes: 21 • No: 0

House vote • 6/24/2025

Passed (2/3 required)

Yes: 40 • No: 0

Actions Timeline

  1. Signed by Governor

    9/3/2025Governor

  2. Passed By Senate. Votes: 21 YES

    6/30/2025Senate

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

    6/25/2025Senate

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

    6/24/2025Senate

  5. Passed By House. Votes: 40 YES 1 VACANT

    6/24/2025House

  6. was introduced and adopted in lieu of HB 212

    6/18/2025House

Bill Text

  • Current

    6/18/2025

    HTML

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