Delaware House Bill 212
Session 153
An Act To Amend Title 18 Of The Delaware Code Relating To Overpayment Recovery And Audit Practices.
Became Law
Signed by Governor on Sep 3, 2025
First Action
Jun 18, 2025
Latest Action
Sep 3, 2025
Origin Chamber
House
Type
Bill
Bill Number
212
State
Delaware
Session
153
checkPassed on June 24, 2025
Motion Text
2/3
House Roll Call Votes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Summary
This Substitute for House Bill No. 212 corrects a technical drafting error to underline new language contained in Section 2 of the Act, and is otherwise identical to House Bill No. 212, which does the following:
Section 1 of this Act amends the time period during which health insurers may initiate overpayment recovery efforts from 24 months to 12 months of a claim being paid. This Act also amends one of the exemptions to the overpayment recovery deadline to require an indication of fraud, abuse, or other intentional misconduct based on a physical review or review of claims data or statements as opposed to merely having a reasonable belief of such fraud, abuse or other intentional misconduct. It aligns requirements for provider-oriented clawbacks with those for pharmacies.
Section 2 of this Act requires written notice from pharmacy benefit managers or entities conducting pharmacy audits. Because Department examinations have indicated that PBMs misuse this provision in the law to conduct audits outside the parameters of the Pharmacy Audit Integrity Program, Section 3 of this Act amends the exclusions to the applicability of the pharmacy audit rules to require that pharmacy benefits managers have more definitive proof, based on physical review of claims data or other investigative methods, to believe misconduct has occurred before the rules related to the Pharmacy Audit Integrity Program become inapplicable to an investigative audit. This Act also makes technical corrections to existing law to conform to the requirements of the Delaware Legislative Drafting Manual.
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09/03/2025
Office of the Governor
Signed by Governor
06/30/2025
Senate
Passed By Senate. Votes: 21 YES
06/25/2025
Senate
Reported Out of Committee (Banking, Business, Insurance & Technology) in Senate with 7 On Its Merits
06/24/2025
Senate
Assigned to Banking, Business, Insurance & Technology Committee in Senate
06/24/2025
House
Passed By House. Votes: 40 YES 1 VACANT
06/18/2025
House
was introduced and adopted in lieu of HB 212
Sources
Open States
Record Created
Jun 10, 2025 6:16:35 PM
Record Updated
Sep 23, 2025 6:21:08 PM