New York A 3365: Limits the lookback period for insurance overpayment recovery from health care providers to twelve months

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A03365 Summary:

BILL NOA03365A

&nbsp

SAME ASSAME AS S05209-A

&nbsp

SPONSORLavine

&nbsp

COSPNSRKelles, Lunsford, Epstein, Brabenec, Clark, Brook-Krasny, Sayegh, Griffin, Simpson, Simon, Stirpe

&nbsp

MLTSPNSR

&nbsp

Amd §3224-b, Ins L

&nbsp

Changes the lookback period for insurance overpayment recovery from health care providers from twenty-four months to twelve months.

Go to top A03365 Actions:

BILL NOA03365A

&nbsp

01/27/2025referred to insurance

05/20/2025amend and recommit to insurance

05/20/2025print number 3365a

01/07/2026referred to insurance

Go to topA03365 Committee&nbspVotes:

Go to topA03365 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA03365 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 3365--A

 2025-2026 Regular Sessions

 IN ASSEMBLY

 January 27, 2025
 ___________

 Introduced by M. of A. LAVINE, KELLES, LUNSFORD, EPSTEIN, BRABENEC --
 read once and referred to the Committee on Insurance -- committee
 discharged, bill amended, ordered reprinted as amended and recommitted
 to said committee

 AN ACT to amend the insurance law, in relation to limiting the lookback
 period for insurance overpayment recovery from health care providers

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Paragraph 3 of subsection (b) of section 3224-b of the
 2 insurance law, as amended by chapter 237 of the laws of 2009, is amended
 3 to read as follows:
 4 (3) A health plan shall not initiate overpayment recovery efforts more
 5 than [twenty-four] twelve months after the original payment was received
 6 by a health care provider. However, no such time limit shall apply to
 7 overpayment recovery efforts that are: (i) based on a reasonable belief
 8 of fraud or other intentional misconduct, or abusive billing, (ii)
 9 required by, or initiated at the request of, a self-insured plan, or
 10 (iii) required or authorized by a state or federal government program or
 11 coverage that is provided by this state or a municipality thereof to its
 12 respective employees, retirees or members. Notwithstanding the aforemen-
 13 tioned time limitations, in the event that a health care provider
 14 asserts that a health plan has underpaid a claim or claims, the health
 15 plan may defend or set off such assertion of underpayment based on over-
 16 payments going back in time as far as the claimed underpayment. For
 17 purposes of this paragraph, "abusive billing" shall be defined as a
 18 billing practice which results in the submission of claims that are not
 19 consistent with sound fiscal, business, or medical practices and at such
 20 frequency and for such a period of time as to reflect a consistent
 21 course of conduct.
 22 § 2. This act shall take effect on the thirtieth day after it shall
 23 have become a law.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD06060-02-5

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