No Surprises Act Enforcement Act
- Sponsor
- Rep. Murphy, Gregory F. [R-NC-3]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jul 23, 2025
Bottom line
The bill aims to strengthen the enforcement of the No Surprises Act by imposing higher financial penalties and increasing transparency in compliance reporting.
What it actually does
This bill significantly increases penalties for health plans, insurance issuers, and nonparticipating providers that violate balance billing requirements under the No Surprises Act. It introduces a new, substantial penalty for late or non-payment following an Independent Dispute Resolution (IDR) determination and expands transparency reporting requirements for enforcement actions related to surprise billing.
Proponents argue
Proponents argue that stronger enforcement mechanisms, including increased penalties and more frequent reporting, are essential to ensure health plans, issuers, and providers comply with the No Surprises Act. They contend that current penalties may not be sufficient to deter violations, leading to continued surprise billing for patients. This bill would provide a more robust deterrent, ultimately protecting consumers from unexpected medical costs.
Opponents contend
Opponents might argue that the proposed penalty increases are excessive and could lead to significant administrative burdens and financial risks for health plans, issuers, and providers. They may contend that such punitive measures could disrupt the existing payment dispute resolution process or lead to higher healthcare costs that are ultimately passed on to consumers. Some may also suggest that the focus should be on streamlining the IDR process rather than escalating penalties.
The bill is relatively short and its core provisions are clearly stated, making it accessible for a reader to understand its primary intent within a reasonable timeframe.
Section 2(a), (b), (c)
Increased Penalties for Balance Billing Violations
This section amends the Public Health Service Act (PHSA), the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code (IRC) to significantly increase the financial penalties for group health plans and health insurance issuers that fail to comply with specific balance billing requirements of the No Surprises Act. For most violations, the penalty increases from $100 per day to $10,000 for each failure (PHSA, IRC) or $10,000 for each individual affected (ERISA).
Supporters argue
Supporters argue that the existing $100 per day penalty is insufficient to deter large health plans and issuers from violating balance billing protections. Increasing the penalty to $10,000 per failure or per individual will create a more meaningful financial incentive for compliance, ensuring patients are truly protected from surprise medical bills.
Critics contend
Critics may contend that such a steep increase in penalties could be disproportionate for certain violations and might lead to an overly punitive regulatory environment. They might argue that it could strain resources for plans and issuers, potentially leading to increased administrative costs that are passed on to consumers.
Tradeoffs
The tension lies between ensuring robust consumer protection through strong deterrents and avoiding excessive penalties that could create undue financial burden or disincentives for plans and providers to offer coverage or services.
Section 3(a), (b), (c)
Additional Penalties for Late or Non-Payment After IDR Determination
This section introduces new penalties related to the Independent Dispute Resolution (IDR) process. If an IDR entity determines that a payment is owed by either a health plan/issuer or a nonparticipating provider/facility, and that payment is not made within 30 days, the defaulting party must pay an additional penalty. This penalty is three times the difference between the initial payment (or $0 if denied) and the final out-of-network rate determined by the IDR process, plus interest. It also requires notification to the Secretary when such payments are made.
Section 4(a), (b)
Expanded Transparency Reporting Requirements
This section amends the Public Health Service Act and the Internal Revenue Code to expand and increase the frequency of transparency reporting related to the No Surprises Act. It changes the reporting schedule from annual to semi-annual (every six months) and requires more detailed information to be submitted to Congress. The expanded report must include the total number of audits conducted, audits initiated by complaints, the number of complaints from providers and consumers, enforcement actions taken, the aggregate dollar amount of civil monetary penalties, non-monetary corrective actions, and the three most commonly reported violations.
The bill specifies the exact provisions of the Public Health Service Act, ERISA, and the Internal Revenue Code that are subject to the increased $10,000 penalty. These include specific subparagraphs and clauses related to emergency services, non-emergency services, and air ambulance services, covering aspects like cost-sharing, notice requirements, and payment rules.
Section 2(a)(2)(iv), (b)(3), (c)(2)(4)
Why it matters:This is standard legislative practice for amending existing law, but it makes the full scope of the increased penalties less immediately apparent to a casual reader who is not familiar with the referenced code sections.
Case for: Proponents would argue that precise statutory references are necessary for legal clarity and to ensure that the increased penalties apply only to the intended violations, avoiding ambiguity in enforcement.
Case against: Critics might argue that the technical nature of these references makes it difficult for affected parties (health plans, providers, and even patients) to easily understand the specific actions that carry significantly higher penalties, potentially hindering proactive compliance.
Estimated impact: Clarifies the specific scope of the increased penalties, potentially impacting a wide range of administrative and billing practices related to surprise medical bills.
The bill establishes a new penalty for late or non-payment following an Independent Dispute Resolution (IDR) entity's payment determination. The penalty is an amount that is three times the difference between the initial payment (or $0 if denied) and the out-of-network rate determined by the IDR process (less any cost sharing).
Section 3(a)(1)(C)(i), (a)(2)(C)(i), (b)(1)(C)(i), (b)(2)(C)(i), (c)(1)(C)(i), (c)(2)(C)(i)
Why it matters:This is a detailed calculation necessary for the precise application of the penalty, but its placement within the text requires careful reading to fully appreciate its impact.
Case for: Proponents would argue that this substantial penalty is necessary to create a strong incentive for timely compliance with IDR determinations, preventing prolonged payment disputes and ensuring the financial stability of providers and plans after a resolution is reached.
Case against: Opponents might argue that a triple penalty is excessively punitive and could lead to unintended consequences, such as increased litigation over payment amounts or a chilling effect on participation in the IDR process due to fear of severe financial repercussions for minor delays.
Estimated impact: Could significantly alter the financial risk associated with payment delays after IDR, potentially leading to faster payments but also higher stakes in disputes.