New York Assembly Bill A03365

New York 2025-2026 Regular Session

• Introduced: 1/27/25
• Refer: 1/27/25
• Refer: 1/7/26

Caption

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

Summary

This bill amends New York Insurance Law section 3224-b to shorten the time period during which a health plan may begin overpayment recovery efforts against a health care provider. Under current law, a health plan generally has 24 months from the date the original payment was received to seek recovery; the bill reduces that lookback period to 12 months. The bill is aimed at giving providers earlier finality on paid claims and limiting how far back insurers can revisit payments. The bill preserves several exceptions to the new 12-month limit. The shorter deadline would not apply where the recovery is based on a reasonable belief of fraud, other intentional misconduct, or abusive billing; where a self-insured plan requests or requires the recovery; or where the recovery is required or authorized by a state or federal government program, including coverage provided by the state or a municipality to employees, retirees, or members. It also allows a health plan to defend against or offset a provider’s underpayment claim using overpayments going back as far as the claimed underpayment.

Impact

The bill would directly amend the Insurance Law by changing the statutory overpayment recovery window for health plans from 24 months to 12 months. In practice, this would limit insurers’ and managed care plans’ ability to recoup alleged overpayments from hospitals, physicians, and other health care providers after one year, while leaving fraud, abusive billing, self-insured plans, and government program recoveries largely unaffected. The change would likely reduce retrospective audit exposure for providers and could require health plans to adjust claims review, audit, and recovery procedures.

Sentiment

The available context suggests the bill is framed as a provider-protection measure and appears to have been introduced without recorded opposition or vote history in the materials provided. Its sponsor list and caption indicate a policy effort to tighten insurer recovery timelines, which generally aligns with concerns from health care providers about delayed recoupments and administrative burden. Because no committee transcript or vote record is included, there is no documented floor or committee sentiment beyond the bill’s apparent support among its sponsors.

Contention

The main point of contention is the balance between provider certainty and insurer/payment integrity. Health care providers are likely to support the shorter 12-month limit because it reduces the risk of long-delayed clawbacks and improves financial predictability. Health plans and insurers may oppose it or seek exceptions because it could restrict their ability to correct payment errors discovered after extended audits, especially in complex claims environments. The bill addresses some of those concerns by preserving exceptions for fraud, intentional misconduct, abusive billing, self-insured plans, and government-related coverage, but the core dispute remains how much time insurers should have to identify and recover overpayments.