Sponsors (2)
The bill strengthens consumer protections and oversight against surprise/balance billing by imposing clearer enforcement duties and stiffer penalties, but it raises compliance and liability costs for insurers and providers that could increase consumer costs, strain smaller providers, and create regulatory and administrative burdens.
Patients (especially those with chronic conditions and uninsured individuals) gain stronger protection from surprise and balance-billing because the bill authorizes larger, clearer penalties and specific enforcement triggers that deter unlawful billing.
Patients and enrollees receive faster remediation when overpayments occur because providers must remit reconciliation payments within 30 days, reducing improper charges and unexpected consumer costs.
Regulators, policymakers, and the public gain more transparency and clearer cross-agency enforcement pathways because plans/providers must notify HHS of reconciliation payments and HHS/Treasury must report audit counts to Congress, helping target oversight.
Insurers, group plans, and providers will face higher compliance costs and exposure to large penalties (including DOL civil fines and treble damages), which will likely be passed on to consumers through higher premiums or increased out-of-pocket costs.
Small and nonparticipating providers face substantial financial liability and cash-flow risk from treble-damage provisions and expanded enforcement, which could prompt some to raise prices, decline out-of-network care, or reduce services—hurting patient access.
Multi-agency enforcement and harmonized but overlapping rules create regulatory complexity and the risk of uneven enforcement, increasing uncertainty for plans and states trying to comply.
Based on analysis of 4 sections of legislative text.
Strengthens enforcement of No Surprises Act billing rules: expands penalty triggers, adds ERISA penalties up to $10,000 per individual, requires 30-day corrective payments after IDR, and sets tougher late-payment penalties.
Official title: 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, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes.
Introduced July 23, 2025 by Roger Wayne Marshall · Last progress July 23, 2025
Expands enforcement of the No Surprises Act by adding specific balance-billing provisions to the list that can trigger civil penalties across federal law, creates a new ERISA civil-penalty authority (up to $10,000 per individual violation) for group plans and issuers, and tightens payment timing and penalties after independent dispute resolution (IDR) decisions. It also clarifies and fixes the statutory reporting period for administrative audits, establishing an initial reporting window beginning in 2022 and requiring annual follow-up reports to Congress. The bill mainly affects health plans, insurers, and out-of-network providers and facilities by increasing compliance obligations, requiring prompt corrective payments when IDR awards are lower than initial plan payments plus enrollee cost-sharing, imposing three-times late-payment penalties plus interest for missed deadlines, and adding cross-reference language across PHSA, ERISA, and the Internal Revenue Code to harmonize enforcement triggers.