Expands federal rules that protect people from surprise balance bills, raises civil penalties for violations, adds rules to force timely payments after independent dispute resolution (IDR) decisions (including notice, interest, and repayment requirements), and requires the Department to report annually to Congress on audits of plans and issuers. The changes amend provisions across the Public Health Service Act, ERISA, and the Internal Revenue Code to add cross-references, enforcement language, and penalties intended to strengthen compliance with balance-billing and IDR outcomes.