Senate BillIntroduced
S 5209: Changes the lookback period for insurance overpayment recovery from health care providers from twenty-four months to twelve months.
What S 5209 does, verified April 28, 2026
The bill aims to limit the lookback period for insurance overpayment recovery from healthcare providers. A health plan cannot initiate overpayment recovery efforts more than twelve months after the original payment was received by a healthcare provider. However, this time limit does not apply in cases of: fraud or intentional misconduct self-insured plans or government programs state or federal government programs provided to employees, retirees, or members In such cases, the healthcare provider can assert that a health plan has underpaid a claim, and the plan can defend or set off the assertion based on overpayments going back in time. The bill defines "abusive billing" as a billing practice that is not consistent with sound fiscal, business, or medical practices. The bill takes effect thirty days after it becomes a law.
Bill journey
1IntroducedCurrent
2In CommitteePending
3First Chamber FloorPending
4Second ChamberPending
5GovernorPending
6ChapteredPending
Last action: REFERRED TO INSURANCE (2026-01-07)Alert me
Quick answers about S 5209
- What is the current status of S 5209?
- As of April 28, 2026, S 5209 is recorded as "Introduced": it has been introduced and is waiting for its first committee hearing or floor vote. The last recorded action, on January 7, 2026, was "REFERRED TO INSURANCE".
- Did S 5209 pass?
- Not yet. S 5209 has been introduced and has not passed either house.
- Who wrote S 5209, and where is it now?
- S 5209 was authored by Sen. Jessica Scarcella-Spanton with 3 coauthors. Its committee of record is Senate Insurance.
Author and sponsors
Full contact details, staff, and committees with Connect, $16/moUnlockRecent actions4 total · showing 4
| 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 |
Latest bill textIntroduced version, February 19, 2025 · 372 words
STATE OF NEW YORK ________________________________________________________________________ 5209 2025-2026 Regular Sessions IN SENATE 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: 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] three 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. LBD06060-01-5
Text of S 5209 as introduced, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions