Sponsors (37)
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
The bill strengthens enforceable protections and oversight to curb surprise medical billing—improving consumer protection and federal data—at the cost of higher compliance burdens, potential fines that may raise premiums, and financial risk to smaller providers that could reduce out-of-network access.
People with employer or individual group health plans (including many middle-class families and patients with chronic conditions) gain stronger, enforceable protections against surprise balance billing as PHSA/ERISA/Tax Code provisions are made enforceable and applied uniformly across agencies.
Plans, issuers, and providers face clearer enforcement and deterrents—Labor Secretary civil penalties (up to $10,000 per affected person) and treble damages plus interest for late repayments—making compliance more likely and speeding resolution of improper billing.
Nonparticipating providers who were overpaid must repay excess amounts quickly (within 30 days) and notify the Secretary when repayments occur, which reduces improper insurer costs and improves federal oversight and data on surprise-billing outcomes.
Small or rural nonparticipating providers face large financial liability (treble damages plus interest and rapid repayment deadlines), which could threaten their viability or cause them to refuse out-of-network care, reducing patient access and choice.
Employers and health plans risk substantial per-person fines (up to $10,000) and increased compliance costs, which insurers may pass on as higher premiums or reduced benefits for middle-class families and small-business employees.
New reporting, repayment, and documentation requirements increase administrative burden and operational costs for plans, issuers, providers, and federal agencies, diverting staff time and resources to compliance and reporting.
Based on analysis of 4 sections of legislative text.
Strengthens enforcement of surprise‑billing rules: adds statutory cross‑references, creates an ERISA civil penalty (up to $10,000/individual), requires IDR shortfall repayment within 30 days, mandates notifications, and imposes treble penalties for late payments.
Strengthens enforcement of federal surprise-billing protections by adding explicit cross-references to No Surprises Act provisions in three federal statutes, creating a new civil-penalty authority under ERISA (up to $10,000 per affected individual), and imposing new payment-recapture, reporting, and treble‑payment penalties when independent dispute resolution (IDR) awards result in amounts lower than a plan's initial payment plus patient cost‑sharing. It also sets a defined reporting window (starting 2022 and ending when a named Act is enacted) for annual audit reports to Congress.