No Surprises Act Enforcement Act

This bill strengthens enforcement of the rules that protect people from surprise medical bills. It raises fines for health plans and insurers that break these rules, up to $10,000 per affected person. It also adds tougher penalties and deadlines so out-of-network providers and health plans settle payments quickly after a dispute decision. Overall, it targets violations of balance billing protections and tightens oversight.

After the payment dispute process sets the final amount, whoever owes must pay within 30 days; if they miss the deadline, they owe triple the difference between the initial payment and the final out-of-network amount, plus interest. If a provider already received more than the final amount, they must refund the extra to the plan within 30 days, and payments must be reported to the federal government. These rules apply to emergency care, nonemergency care, and air ambulance services. The bill also requires regular reports to Congress—twice a year starting the first calendar year after it becomes law—covering audits, complaints, penalties, and the most common violations, and it includes audit counts going back to 2022.

• Who is affected: People with health insurance; out-of-network doctors, hospitals, and air ambulance companies; employer health plans and insurers.
• What changes: Bigger fines for breaking surprise billing rules; 30-day pay/refund deadline; triple-penalty plus interest for late or missed payments; payment reporting to the government; regular enforcement reports to Congress .
• When: After it becomes law; twice-yearly reporting begins the first calendar year after enactment; includes audit data since 2022.