Bill Commons

DE HB 212

enacted

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO OVERPAYMENT RECOVERY AND AUDIT PRACTICES.

Delaware · 2025-2026 Regular Session (153rd General Assembly) · lower

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Quick answers

Did DE HB 212 pass?

Yes. DE HB 212 has been enacted into law. Latest recorded action (2025-09-03): Signed by Governor

What is DE HB 212 about?

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.

Who sponsors DE HB 212?

David L. Wilson, Nicole Poore, Claire Snyder-Hall and 4 others are the primary sponsors of DE HB 212.

Description

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.

Introduced
2025-06-18
Latest action
2025-09-03 — Signed by Governor
Bill type
bill
Last updated
—

Sponsors

  • David L. Wilsonprimary
  • Nicole Pooreprimary
  • Claire Snyder-Hallprimary
  • Darius J. Brownprimary
  • Bryan Townsendprimary
  • Spiros Mantzavinosprimary
  • William Bushprimary

Committees

Not provided by source.

Action timeline

Newest first

  1. 2025-09-03

    Signed by Governor

    executive-signature

  2. 2025-06-30

    Passed By Senate. Votes: 21 YES

    passage

  3. 2025-06-25

    Reported Out of Committee (Banking, Business, Insurance & Technology) in Senate with 7 On Its Merits

    committee-passage

  4. 2025-06-24

    Assigned to Banking, Business, Insurance & Technology Committee in Senate

    introduction,referral-committee

  5. 2025-06-24

    Passed By House. Votes: 40 YES 1 VACANT

    passage

  6. 2025-06-18

    was introduced and adopted in lieu of HB 212

    introduction

Versions

Not provided by source.

Documents

Not provided by source.

Votes

  • 2/3

    2025-06-24 · pass · 40-0

    Member-level votes (40)
    • Stephanie T. Bolden: yes
    • Frank Burns: yes
    • William Bush: yes
    • William J. Carson: yes
    • Nnamdi O. Chukwuocha: yes
    • Richard G. Collins: yes
    • Franklin D. Cooke: yes
    • Daniel B. Short: yes
    • Timothy D. Dukes: yes
    • Mara Gorman: yes
    • Ronald E. Gray: yes
    • Krista Griffith: yes
    • Kerri Evelyn Harris: yes
    • Debra Heffernan: yes
    • Kevin S Hensley: yes
    • Jeff Hilovsky: yes
    • Valerie Jones Giltner: yes
    • Kendra Johnson: yes
    • Kimberly Williams: yes
    • Kamela T Smith: yes
    • Larry Lambert: yes
    • Sean M. Lynn: yes
    • Michael F. Smith: yes
    • Melissa Minor-Brown: yes
    • Shannon Morris: yes
    • Eric Morrison: yes
    • DeShanna U Neal: yes
    • Josue O Ortega: yes
    • Edward S. Osienski: yes
    • Sophie Phillips: yes
    • Charles S Postles Jr.: yes
    • Cyndie Romer: yes
    • Melanie Ross Levin: yes
    • Sherae'a Moore: yes
    • Bryan W. Shupe: yes
    • Claire Snyder-Hall: yes
    • Jeffrey N. Spiegelman: yes
    • Jesse R. Vanderwende: yes
    • Madinah Wilson-Anton: yes
    • Lyndon D. Yearick: yes

  • SM

    2025-06-30 · pass · 21-0

    Member-level votes (21)
    • Darius J. Brown: yes
    • Eric Buckson: yes
    • Daniel Cruce: yes
    • Stephanie L. Hansen: yes
    • Gerald W. Hocker: yes
    • Kyra L. Hoffner: yes
    • Russell Huxtable: yes
    • Dave G. Lawson: yes
    • S. Elizabeth Lockman: yes
    • Spiros Mantzavinos: yes
    • Trey Paradee: yes
    • Brian Pettyjohn: yes
    • Marie Pinkney: yes
    • Nicole Poore: yes
    • Bryant L. Richardson: yes
    • Ray Seigfried: yes
    • David P. Sokola: yes
    • Laura V. Sturgeon: yes
    • Bryan Townsend: yes
    • John "Jack" Walsh: yes
    • David L. Wilson: yes

Related bills

No related bills recorded for this bill.

Official source

https://legis.delaware.gov/BillDetail?LegislationId=142578

Attribution

Data from openstates_bulk_csv, retrieved 2026-07-24T03:53:51.443619Z

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