In committee
No Surprises Act Enforcement Act
This bill increases financial penalties on health insurance plans that violate federal protections against surprise medical bills, raising fines up to $10,000 per violation. It also enforces strict payment deadlines between insurers and out-of-network doctors, hospitals, and air ambulance services after billing disputes are settled. If either an insurer or a medical provider fails to pay a resolved balance on time, they must pay triple the unpaid amount plus interest to the other party, while federal agencies must report enforcement actions to Congress every six months.
People affected—not determinable from the text provided; broadly covers participants in group health plans, insurance issuers, and out-of-network healthcare providers, but specifies no quantitative population size
Fiscal magnitude—no CBO estimate published
Reach54provisional · pending reviewrigor: heuristic llm
What this bill touches.
Market protections+45Government role in coverage+35Regulation (cross-sector)+45
Who it helps · who it burdens.
Who it helps
- Health insurance issuers and group health plansEntitled under Sec. 3 to receive refunds within 30 days from out-of-network providers when an independent dispute resolution determination is lower than initial payments, and to receive three times the owed amount plus interest if a provider fails to pay on time.
- Out-of-network healthcare providers, facilities, and air ambulance servicesEntitled under Sec. 3 to receive treble damages (three times the owed amount) plus interest from health plans or insurers that fail to make required dispute resolution payments on time.
Who it burdens
- Health insurance issuers and group health plansFace substantially higher civil penalties (increased from $100 per day to $10,000 per violation or affected individual) for noncompliance with federal surprise billing protections, must notify the federal government when dispute payments are made, and face treble damages (three times the owed amount plus interest) for late dispute resolution payments under Sec. 2 and Sec. 3.
- Out-of-network healthcare providers, facilities, and air ambulance servicesRequired under Sec. 3 to refund health plans within 30 days when a dispute resolution outcome is lower than the initial payment, submit payment notifications to the federal government on the date payments are made, and pay triple the owed amount plus interest if required dispute settlement payments are made late.
- Departments of Health and Human Services, Labor, and the TreasuryRequired under Sec. 4 to coordinate and submit biannual reports to relevant congressional committees on audits and enforcement actions related to surprise billing compliance.