Assembly Bill A3365

2025-2026 Legislative Session

Limits the lookback period for insurance overpayment recovery from health care providers to three months

download bill text pdf

Sponsored By

Current Bill Status - In Assembly Committee

  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2025-A3365 (ACTIVE) - Details

See Senate Version of this Bill:
S5209
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3224-b, Ins L
Versions Introduced in 2023-2024 Legislative Session:
A7590, S7076

2025-A3365 (ACTIVE) - Summary

Limits the lookback period for insurance overpayment recovery from health care providers to three months.

2025-A3365 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3365
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 27, 2025
                                ___________
 
 Introduced  by  M. of A. LAVINE, KELLES -- read once and referred to the
   Committee on Insurance
 
 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:
 
   Section 1. Paragraph 3 of subsection (b)  of  section  3224-b  of  the
 insurance law, as amended by chapter 237 of the laws of 2009, is amended
 to read as follows:
   (3) A health plan shall not initiate overpayment recovery efforts more
 than  [twenty-four] THREE months after the original payment was received
 by a health care provider. However, no such time limit  shall  apply  to
 overpayment  recovery efforts that are: (i) based on a reasonable belief
 of fraud or other  intentional  misconduct,  or  abusive  billing,  (ii)
 required  by,  or  initiated  at the request of, a self-insured plan, or
 (iii) required or authorized by a state or federal government program or
 coverage that is provided by this state or a municipality thereof to its
 respective employees, retirees or members. Notwithstanding the aforemen-
 tioned time limitations, in  the  event  that  a  health  care  provider
 asserts  that  a health plan has underpaid a claim or claims, the health
 plan may defend or set off such assertion of underpayment based on over-
 payments going back in time as far as the  claimed  underpayment.    For
 purposes  of  this  paragraph,  "abusive  billing" shall be defined as a
 billing practice which results in the submission of claims that are  not
 consistent with sound fiscal, business, or medical practices and at such
 frequency  and  for  such  a  period  of time as to reflect a consistent
 course of conduct.
   § 2. This act shall take effect on the thirtieth day  after  it  shall
 have become a law.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06060-01-5

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