Insurers and health plans could not use later claims to recover overpayments

If enacted, insurers and health maintenance organizations (health plans) could not adjust a provider’s later claim to recover an earlier overpayment. This applies when a provider files a later claim after the insurer or health plan overpaid the provider on an earlier claim. The proposed rule would take effect July 1, 2026, if enacted.

If enacted, insurers and health plans could not request repayment more than one year after paying an overpayment to a provider. This applies to overpayments made to providers by insurers and health maintenance organizations. The rule would not apply when the claim’s overpayment or underpayment involved fraud by the provider, the insured or enrollee, or the insurer or health plan. The proposed rule would take effect July 1, 2026, if enacted.