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DelawareHS 1 for HB 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: Sponsor information unavailable

Signed by Governor

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Bill Overview

Analyzed Economic Effects

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

Shorter lookback, fairer audits for providers

Insurers and health plans have 12 months from the original payment to start overpayment recovery. “Start” means the first audit report or similar notice that flags an error. The 12‑month limit does not apply for fraud, abuse, or intentional misconduct shown by physical or claims‑data review, for self‑insured plan requests, or for state or federal plan recoveries. Overpayment findings must use actual amounts, not projections; audits cannot use extrapolation unless higher law requires it. When a pharmacy benefit manager (PBM) seeks a recoupment or chargeback, it must send the pharmacy a written notice that names the error and explains the reason.

Fraud probes skip pharmacy audit protections

The Pharmacy Audit Integrity rules do not apply during investigative audits for suspected fraud or willful misconduct. This includes cases shown by a physical review or by claims‑data review, or where other methods point to criminal wrongdoing. The rules also do not apply when the State conducts the audit. In these cases, pharmacies lose the subchapter’s special limits and procedures.

Sponsors & Cosponsors

Sponsors

There is no primary sponsor on record.

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 61 • No: 0

Senate vote • 7/1/2025

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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