Sponsors (32)
Introduced July 23, 2025 by Gregory Francis Murphy · Last progress July 23, 2025
The bill strengthens enforceable protections against surprise billing and increases federal oversight, but it does so by imposing substantial penalties and new reporting/compliance obligations that could raise costs for providers, plans, employers, and ultimately patients while risking reduced access in some areas.
People with employer-based or individual group health plans (millions of enrollees, including middle-class families) gain stronger, enforceable protections against surprise balance-billing by making PHSA/ERISA/Tax Code provisions uniformly enforceable across agencies.
Group health plans and issuers face a new federal enforcement tool because the Labor Secretary can impose civil penalties (up to $10,000 per affected individual), which increases deterrence against noncompliance and may improve plan behavior.
Group health plans and patients (especially those with chronic conditions) benefit from a requirement that nonparticipating providers repay overpayments within 30 days and face treble damages plus interest for delayed repayment, encouraging faster resolution and recovery of improper payments.
Smaller and rural hospitals and nonparticipating providers face large potential financial liability (treble damages plus interest) that could threaten their financial viability or prompt them to stop accepting out-of-network patients.
Employers, health plans, and ultimately enrollees (including middle-class families and small-business employees) could face substantial fines and higher compliance costs — penalties up to $10,000 per affected person and new documentation requirements may be passed through as higher premiums or reduced benefits.
Patients (including Medicaid beneficiaries) may experience reduced access and choice if providers respond to new financial risks by limiting out-of-network care or shifting costs, potentially harming continuity of care for vulnerable populations.
Based on analysis of 4 sections of legislative text.
Strengthens No Surprises Act enforcement by creating ERISA civil penalties, requiring IDR-related repayments and reporting, and imposing treble damages for late payments.
Creates stronger enforcement tools for the No Surprises Act by adding aligned penalty cross-references across the Public Health Service Act, ERISA, and the Internal Revenue Code, and by creating a new ERISA civil-penalty authority. Requires nonparticipating providers/facilities to repay plans when an independent dispute resolution (IDR) sets the payable amount below what the plan already paid plus patient cost-sharing, mandates reporting to the Secretary when such payments occur, and imposes treble damages plus interest for late payments; also sets defined annual reporting years beginning in 2022 through the year a named "Enhanced Enforcement" Act is enacted.