Sponsors (2)
Introduced July 23, 2025 by Roger Wayne Marshall · Last progress July 23, 2025
The bill strengthens enforcement, remittance rules, and transparency to better protect patients from surprise billing, but does so by increasing penalties and multi‑agency compliance demands that may raise costs for insurers and providers and could reduce access for some patients.
Patients (including people with chronic conditions and uninsured individuals) gain stronger protection from surprise/balance billing because the bill expands enforceable violations, requires providers to remit overpayments quickly, and creates clearer enforcement paths that make it easier to stop improper billing.
Group plan members and enrollees benefit from clearer enforcement pathways and interagency harmonization (HHS, DOL, Treasury), which should make it easier to resolve disputes and hold plans accountable under ERISA and tax-code cross-references.
Stronger financial deterrents (DOL civil penalties and the possibility of treble damages plus interest) create a powerful incentive for plans and providers to comply, which should reduce unlawful billing and speed reconciliations over time.
Health insurers and group plans will face higher compliance costs and exposure to large penalties, which could be passed on to consumers as higher premiums or increased administrative burdens for employers and households.
Nonparticipating and smaller providers face the risk of large financial liability (treble damages plus interest), which could create severe cash-flow pressure or financial distress for some hospitals and provider groups.
Providers may respond to increased liability risk by raising prices or refusing out‑of‑network care, which could reduce timely access to emergency or specialty services for patients.
Based on analysis of 4 sections of legislative text.
Strengthens No Surprises Act enforcement: harmonizes cross-references, adds ERISA civil penalties (up to $10,000/person), requires 30-day returns after IDR, and adds treble-style late-payment penalties and reporting starting 2022.
Expands enforcement of the No Surprises / balance-billing rules by adding specific statutory cross-references across the Public Health Service Act, ERISA, and the Internal Revenue Code, creating a new civil-penalty authority under ERISA (up to $10,000 per individual per violation), and strengthening payment timing, notification, and penalties after independent dispute resolution (IDR) decisions (including a 30-day return requirement and a treble/interest late-payment penalty). It also sets an explicit initial reporting window beginning in 2022 for annual HHS reports to Congress on audits of plans and issuers and requires continued annual reporting thereafter. The measure mainly affects nonparticipating providers/facilities, group health plans and issuers, and patients who receive out-of-network emergency or certain nonemergency services by increasing enforcement tools, adding new monetary penalties and timelines, and tightening reporting requirements for regulators.