Sponsors (36)
The bill strengthens and enforces protections against surprise balance-billing—giving consumers clearer rights and federal enforcement tools—at the cost of higher penalties and new compliance/reporting burdens that may raise plan costs, spur litigation, and strain small providers and administrative agencies.
People with employer or individual group plans (millions of Americans) gain clearer, enforceable protection against surprise balance-billing because PHSA/ERISA/Tax Code cross-references are aligned and civil penalties are made available to deter noncompliance.
Nonparticipating providers who were overpaid must repay excess amounts within 30 days and notify the Secretary; treble damages plus interest for failure provide a strong deterrent that can speed resolution, reduce improper insurer costs, and protect patients from lingering balance-billing disputes.
Federal annual, standardized reporting on how many health plans were audited (and aligned PHSA/IRC reporting windows) improves short-term transparency and coordination between HHS and Treasury for evaluating enforcement over the specified period.
Employers and health plans face significant per-person penalties and new documentation/reporting requirements, increasing compliance costs that are likely to be passed on to consumers through higher premiums or reduced benefits.
The statute's new cross-references and per-person penalty structure create risk of uneven enforcement and litigation as agencies interpret obligations, producing legal uncertainty and potential costs for employers, insurers, and plans.
Treble damages plus interest and strict repayment timing could impose large financial liabilities on smaller or rural providers, threatening their viability or prompting them to decline out-of-network care, which would reduce patient access and choice.
Based on analysis of 4 sections of legislative text.
Strengthens surprise-billing enforcement by adding ERISA civil penalties (up to $10,000 per person), requiring repayments and reporting, and imposing treble penalties for late payments.
Introduced July 23, 2025 by Gregory Francis Murphy · Last progress July 23, 2025
Adds new enforcement tools for federal surprise-billing rules by (1) expanding statute cross-references in three federal codes, (2) creating a new civil-penalty authority under ERISA (up to $10,000 per affected individual) for failures to follow certain balance-billing protections, (3) requiring payback and reporting when an independent dispute resolution (IDR) award is less than the plan's initial payment plus patient cost-sharing, and (4) imposing a treble-payment penalty plus interest for late or missing reimbursements. Also sets a defined multi-year audit-reporting window beginning in 2022 and ending on the December 31 of the year a separate named enforcement Act is enacted.