Sponsors (37)
The bill strengthens enforceable protections and federal oversight to reduce surprise billing for consumers, at the expense of imposing significant financial and administrative burdens on providers, plans, employers, and agencies that could raise costs or reduce access in some markets.
People with employer or individual group health plans gain stronger, enforceable protections against surprise balance-billing because the bill makes specific PHSA/ERISA/Tax Code provisions enforceable and authorizes civil penalties for noncompliance.
Nonparticipating providers who were overpaid must repay excess amounts within 30 days and face treble damages plus interest for late repayment, which reduces improper insurer costs, discourages inflated billing, and speeds resolution for patients and plans.
Federal agencies will provide standardized annual data and require notifications when repayments are made, improving transparency and oversight of surprise-billing enforcement for policymakers and the public.
Small or rural nonparticipating providers face large financial liability from prompt repayment plus treble damages and interest, which could threaten facility viability or lead providers to refuse out-of-network care, reducing patient access.
Employers and health plans could face civil penalties up to $10,000 per affected person and new compliance costs, which may be passed to consumers as higher premiums or reduced benefits.
New documentation, repayment, notification, and audit-reporting requirements increase administrative burden for plans, issuers, and federal staff, raising overhead and implementation costs across stakeholders.
Based on analysis of 4 sections of legislative text.
Adds repayment, reporting, and treble-penalty rules plus a new ERISA civil penalty (up to $10,000 per individual) to strengthen enforcement of surprise-billing protections and sets an annual audit-reporting period beginning 2022.
Official title: To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes.
Introduced July 23, 2025 by Gregory Francis Murphy · Last progress July 23, 2025
Adds new civil-penalty authority, payment-repayment, reporting, and audit-reporting rules to strengthen enforcement of federal surprise-billing protections. It requires nonparticipating providers and facilities to repay plans when independent dispute resolution (IDR) awards are lower than initial plan payments plus patient cost-sharing, requires notification to the Secretary when such payments occur, and creates treble-payment penalties plus interest for missed repayments. Also aligns cross-references in the Public Health Service Act and the Internal Revenue Code to list the same No Surprises Act provisions and directs annual audit reporting beginning 2022 and continuing until the enactment of a named enhanced-enforcement law.