| Date of Action |
Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|---|---|
| Jan 07, 2026 |
referred to insurance |
| May 20, 2025 |
print number 5209a |
| May 20, 2025 |
amend and recommit to insurance |
| Feb 19, 2025 |
referred to insurance |
Senate Bill S5209A
2025-2026 Legislative Session
Sponsored By
(D) 23rd Senate District
Current Bill Status - In Senate Committee Insurance Committee
Actions
Bill Amendments
co-Sponsors
(D) 42nd Senate District
(R, C) 38th Senate District
2025-S5209 - Details
- See Assembly Version of this Bill:
- A3365
- Current Committee:
- Senate Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §3224-b, Ins L
- Versions Introduced in 2023-2024 Legislative Session:
-
S7076, A7590
2025-S5209 - Sponsor Memo
BILL NUMBER: S5209
SPONSOR: SCARCELLA-SPANTON
TITLE OF BILL:
An act to amend the insurance law, in relation to limiting the lookback
period for insurance overpayment recovery from health care providers
PURPOSE OR GENERAL IDEA OF BILL:
This bill amends section 3224-b(b) of the Insurance Law by setting the
overpayment recovery effort window for health plans to three months.
JUSTIFICATION:
This legislation seeks to address some of the difficulties faced by
healthcare providers when dealing with health insurance plans. Under
current law, an insurance company must pay a claim within 45 days of
submission. However, once a claim is paid, an insurance company can
still seek to recover this payment for up to two years after the claim
was made. Insurance companies can withhold money owed to health care
providers in an attempt to collect alleged overpayments from past
2025-S5209 - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5209
2025-2026 Regular Sessions
I N S E N A T E
February 19, 2025
___________
Introduced by Sen. SCARCELLA-SPANTON -- read twice and ordered printed,
and when printed to be committed 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
co-Sponsors
(D) 42nd Senate District
(R, C) 38th Senate District
2025-S5209A (ACTIVE) - Details
- See Assembly Version of this Bill:
- A3365
- Current Committee:
- Senate Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §3224-b, Ins L
- Versions Introduced in 2023-2024 Legislative Session:
-
S7076, A7590
2025-S5209A (ACTIVE) - Sponsor Memo
BILL NUMBER: S5209A
SPONSOR: SCARCELLA-SPANTON
TITLE OF BILL:
An act to amend the insurance law, in relation to limiting the lookback
period for insurance overpayment recovery from health care providers
PURPOSE OR GENERAL IDEA OF BILL:
This bill amends section 3224-b(b) of the Insurance Law by setting the
overpayment recovery effort window for health plans to three months.
JUSTIFICATION:
This legislation seeks to address some of the difficulties faced by
healthcare providers when dealing with health insurance plans. Under
current law, an insurance company must pay a claim within 45 days of
submission. However, once a claim is paid, an insurance company can
still seek to recover this payment for up to two years after the claim
was made. Insurance companies can withhold money owed to health care
providers to collect alleged overpayments from past patient claims.
2025-S5209A (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5209--A
2025-2026 Regular Sessions
I N S E N A T E
February 19, 2025
___________
Introduced by Sens. SCARCELLA-SPANTON, SKOUFIS, WEBER -- read twice and
ordered printed, and when printed to be committed 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:
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] TWELVE 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.
LBD06060-03-5
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