Congress tightens surprise-billing enforcement with steep new penalties

What it does

This bill strengthens enforcement of the No Surprises Act by increasing civil penalties for health plans, insurers, and out-of-network providers that violate balance-billing rules. It raises base penalties from $100 to $10,000 per violation for specific balance-billing breaches, adds a three-times-penalty for late or non-payment after an independent dispute resolution (IDR) determination, and requires regular congressional reporting on audits and enforcement actions. The bill directly benefits patients by making it more costly for plans and providers to ignore surprise-billing protections.

Why we flagged it

The bill's core mechanism is increasing civil penalties and adding late-payment penalties to enforce existing balance-billing protections under the No Surprises Act. It is a regulatory enforcement tool, not a new substantive right.

What the text implies

• The three-times penalty for late/non-payment may incentivize plans and providers to settle IDR determinations quickly, potentially reducing litigation costs but also creating pressure to accept unfavorable determinations to avoid the penalty multiplier.
• Reporting requirements to Congress every 6 months create a new transparency mechanism but do not establish a public-facing database—patients and providers may not have direct access to enforcement data.
• The bill applies uniformly across all balance-billing violations but does not distinguish between good-faith payment delays and intentional non-compliance, potentially penalizing administrative errors equally with deliberate violations.
• Nonparticipating providers are required to pay back to plans when IDR determinations are lower than their initial charges, creating a financial incentive for providers to avoid out-of-network status or to challenge IDR determinations more aggressively.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

The bill strengthens protections against surprise medical bills—a major source of financial harm to patients—by making violations significantly more expensive for plans and providers to ignore. Patients benefit from stronger enforcement incentives, though the penalties flow to plans/providers rather than directly to harmed individuals.

Who stands to gain

• health insurance plans and issuers (reduced out-of-network payment obligations via IDR enforcement)
• self-insured employer plans (ERISA-covered plans subject to the same enforcement)
• independent dispute resolution entities (increased volume of disputes and enforcement actions)

Named in the bill

Health Insurance Issuers, Group Health Plans, Nonparticipating Providers and Facilities, Independent Dispute Resolution (IDR) Entities, Secretary of Health and Human Services (HHS), Secretary of Labor (DOL), Secretary of Treasury, Public Health Service Act (PHSA), Employee Retirement Income Security Act (ERISA), Internal Revenue Code (IRC), No Surprises Act, Committee on Ways and Means — and 2 more

Where it stands

1 cosponsor: 1 Democrats.

• Jul 23, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• Jul 23, 2025 — Referred to Senate Committee on Health, Education, Labor, and Pensions · Congress.gov: “Read twice and referred to the Committee on Health, Education, Labor, and Pensions”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

28 lobbying clients named this bill on 35 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $16,702,995 in lobbying spend. A filing names 12 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 98% of bills with at least one filing.

Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle. $4,000 of that came from 1 PAC tied to these lobbying clients.

• American Medical Association — $5,643,000 on 2 filings
• Lockheed Martin Corporation — $4,180,000 on 1 filing
• Cambia Health Solutions — $1,330,000 on 2 filings
• Blue Cross and Blue Shield Association — $990,000 on 1 filing
• Health Care Service Corporation, a Mutual Legal Reserve Company (hcsc) — $720,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.