No Surprises Act Gets Triple-Penalty Enforcement Power: Late Payments Now Cost Plans and Providers Three Times the Bill

The “No Surprises Act Enforcement Act” is exactly what it sounds like: a bill designed to put serious teeth into the existing federal law that protects you from unexpected medical bills. It does this by drastically increasing the financial penalties for health plans, insurance companies, and even providers who break the rules, particularly around payment deadlines. Specifically, it hikes the minimum civil penalty for balance billing violations and introduces a massive new penalty—three times the amount owed plus interest—for any party that misses a 30-day deadline to pay up after a final payment determination.

When the Fine Print Gets Expensive

Remember the original No Surprises Act? It was supposed to stop you from getting hit with huge bills when you unknowingly received care from an out-of-network provider during an emergency or at an in-network facility. This new bill targets the plans and providers who don't follow those rules. Under Section 2, the minimum penalty for a health plan or insurance issuer violating balance billing protections is increasing from a token $100 per violation to a higher starting amount, with the maximum penalty under ERISA jumping up to $10,000 per violation for each person affected. Think of it as moving from a slap on the wrist to a serious financial deterrent if they try to pass on surprise bills to you.

The 30-Day Clock and the Triple Threat

The biggest change, detailed in Section 3, deals with what happens after a payment dispute is settled. When a health plan and a provider can't agree on the cost of an out-of-network service (like an emergency room visit or air ambulance), they go through a process called Independent Dispute Resolution (IDR). Once the IDR entity decides the final payment amount, the losing party has 30 days to pay. If they miss that deadline, they don't just owe the original amount.

They now face a penalty equal to three times the difference between the initial payment and the established out-of-network rate, plus interest. This applies equally to plans that drag their feet paying providers, and to providers who might owe the plan money back if the IDR determines the initial payment was too high. For example, if a plan owes a provider $5,000 and misses the 30-day window, the plan could suddenly owe the $5,000 plus a penalty of $15,000. This massive financial risk is designed to ensure that payments determined by the IDR process are made immediately and without delay.

More Eyes on the Enforcement

Section 4 is all about transparency and accountability. Currently, the government reports annually on their audits. Once this new Enforcement Act passes, that changes dramatically. The relevant government agencies (HHS, Labor, and Treasury) will have to send detailed reports to Congress every six months. These reports must break down the total number of audits performed, how many complaints were received from both patients and providers, the total number of penalties issued, and the total dollar amount collected.

For regular folks, this means that the enforcement process itself becomes much more transparent. If plans or providers are consistently violating the rules, Congress will know about it twice a year, making it harder for repeat offenders to fly under the radar. This increased oversight is crucial for making sure that the protections written into law actually work in the real world.