HR 4710119th CongressIn Committee

No Surprises Act Enforcement Act

Introduced: Jul 23, 2025

Sponsor: Rep. Murphy, Gregory F. [R-NC-3] (R-North Carolina)

Healthcare

Standard Summary

Comprehensive overview in 1-2 paragraphs

No Surprises Act Enforcement Act would significantly tighten enforcement of balance-billing protections. It raises penalties for group health plans and health insurance issuers that violate balance-billing requirements, adds new penalties for late payment after an independent dispute resolution (IDR) determination, and expands penalties for emergency services and air ambulance scenarios. The bill also strengthens transparency by mandating more detailed reporting to Congress about audits, enforcement actions, complaints, and penalties. In short, it aims to deter balance-billing abuses more aggressively and improve accountability across employers, insurers, and providers. Key mechanics include higher per-failure penalties (up to $10,000 per violation for specified provisions), new per-individual penalties for noncompliance, and harsh penalties for failure to timely pay after IDR outcomes. The changes would apply to the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code (IRC), covering emergency and nonemergency services as well as air ambulance services.

Key Points

1Higher penalties for balance-billing violations
2- PHSA: Penalties increased to up to $10,000 per failure for specified balance-billing provisions.
3- ERISA and IRC: New penalties up to $10,000 per individual for failing to comply with specified balance-billing rules.
4- The bill specifies which provisions carry these higher penalties (a defined list tied to balance-billing requirements).
5New penalties for late payment after IDR determinations
6- For emergency and nonemergency services (PHSA and ERISA) and related IRC provisions, plans or nonparticipating providers/facilities must pay three times the difference between the initial payment (or zero if denied) and the out-of-network rate, plus interest, if they do not pay within the required window after an IDR decision.
7- Applies to both general services and air ambulance services.
8Penalties for late payment or non-payment across multiple programs
9- The same enhanced late-payment penalties apply to PHSA sections for emergency/nonemergency services and air ambulance, ERISA sections for the same, and IRC sections that mirror these rules.
10Expanded transparency and reporting
11- Adds annual and semiannual reporting requirements to Congress about audits, enforcement actions, complaints, penalties, corrective actions, and common violations.
12- Reports cover audits under the act, enforcement actions, and breakdowns of violations across the applicable sections (with specific metrics and timelines).

Impact Areas

Primary group/area affected- Patients and enrollees who receive out-of-network or balance-billed care, especially in emergencies or when cared for by out-of-network providers.- Health plans, group health plans, and health insurance issuers offering group or individual coverage.- Health care providers (including nonparticipating providers and air ambulance operators) who may face penalties for balance-billing violations or for late payments after IDR determinations.Secondary group/area affected- Employers and sponsor organizations that offer group health plans (through ERISA).- Government and administrative bodies responsible for health coverage enforcement (HHS, Treasury, Department of Labor) due to expanded penalties and reporting.Additional impacts- Compliance burden and administrative costs for plans, issuers, and providers due to higher penalties and required reporting.- Potential pressure on health care pricing and settlement practices as entities adjust to stricter enforcement.- More granular public accountability through congressional reporting, which could influence policy discussions and future reforms.

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