SD HB1292

Health carriers may only recoup, recover, or retroactively deny previously paid claims within 18 months of payment, and must provide written notice of the reason to the provider

Exceptions to the 18-month limit include claims involving fraud/waste/abuse, duplicate payments, and services covered by casualty insurance, ERISA self-insured plans, Medicare, Medicaid, workers' compensation, or other federal programs

Providers who must repay claims owe only the original payment amount with no additional fees, penalties, or interest

"Medical services" under this law excludes dental services, pharmaceutical services, and prescription drugs/supplies

Violations are enforceable by the Division of Insurance; applies to claims for services provided on or after July 1, 2026