The "No Surprises Act Enforcement Act" aims to strengthen the enforcement of existing balance billing protections under the Public Health Service Act, ERISA, and the Internal Revenue Code. This legislation introduces substantial increases in penalties for non-compliance by group health plans and health insurance issuers. It also establishes new financial consequences for both plans and providers who fail to adhere to payment determinations made through the independent dispute resolution process.

Specifically, the bill amends current law to raise the civil penalty for group health plans and health insurance issuers from $100 to $10,000 per violation for specific failures related to balance billing requirements. These violations include those concerning out-of-network emergency services, certain non-emergency services provided at in-network facilities, and air ambulance services. This aims to create a stronger deterrent against practices that lead to surprise medical bills for consumers.

Furthermore, the Act introduces new penalties for late or non-payment following a determination by an Independent Dispute Resolution (IDR) entity. If a required payment is not made within 30 days of the IDR determination, the non-compliant party—whether a plan, issuer, or nonparticipating provider/facility—must pay an additional penalty. This penalty is set at three times the difference between the initial payment (or $0 if payment was denied) and the final out-of-network rate determined by the IDR process, plus interest.

To enhance accountability and oversight, the bill mandates increased transparency reporting requirements. The Secretary of Health and Human Services, in coordination with the Secretaries of Labor and the Treasury, will be required to submit semi-annual reports to Congress. These reports will detail the number of audits conducted, enforcement actions taken, the volume of complaints received from both providers and consumers, the total and aggregate amounts of civil monetary penalties issued, and a summary of non-monetary corrective actions. The reports will also highlight the three most commonly reported violations, providing valuable insights into areas needing further attention.