Sponsors (39)
The bill strengthens enforceable protections and federal oversight to curb surprise balance-billing—but does so by creating significant penalty and reporting regimes that raise compliance costs, legal uncertainty, and risks to provider viability and patient access.
People with employer-sponsored or individual group plans gain stronger, enforceable protections against surprise balance-billing (clear statutory authority and penalties), reducing unexpected bills for many consumers.
Group health plans and issuers are subject to a new enforcement tool (Labor Secretary civil-penalty authority), which creates a deterrent to noncompliance and can improve plan-level adherence to balance-billing rules.
Nonparticipating providers who were overpaid must repay excesses within 30 days (with strong penalties for delay), which reduces improper insurer costs, discourages inflated billing, and speeds resolution for plans and patients.
Employers and health plans face the risk of substantial per-person fines (up to $10,000), increasing compliance costs that are likely to be passed on to consumers through higher premiums.
Nonparticipating providers—especially small or rural hospitals and clinics—face large financial liability (treble damages plus interest) that could threaten viability or prompt refusal of out-of-network care, reducing patient access.
Providers may respond to new liabilities by shifting costs or restricting out-of-network access, which can reduce patient choice and increase network limitations for vulnerable populations.
Based on analysis of 4 sections of legislative text.
Strengthens enforcement of the No Surprises Act by adding civil penalties, repayment and reporting requirements for IDR outcomes, and treble penalties for missed repayments.
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 enforcement tools for the No Surprises Act by creating a civil-penalty authority, requiring prompt repayment when independent dispute resolution (IDR) reduces payment, mandating reporting of such repayments, and setting a multiyear reporting window for audits. It amends the Public Health Service Act, ERISA, and the Internal Revenue Code to align cross‑references and to impose new monetary penalties and notification obligations on plans, issuers, and nonparticipating providers/facilities. The bill requires nonparticipating providers/facilities to repay plans when an IDR determination awards less than the plan's initial payment plus patient cost-sharing, requires notices to HHS when such repayments occur, authorizes civil penalties (up to $10,000 per affected individual) for ERISA-covered plans/issuers that violate specified balance‑billing protections, and imposes treble-payment penalties plus interest for missed required repayments. It also fixes a defined reporting period (starting 2022 through the year the named Enhanced Enforcement Act is enacted) for annual audit reports to Congress.