HB 4710 strengthens enforcement of the No Surprises Act by increasing civil penalties and creating new monetary punishments for both group health plans/issuers and nonparticipating providers. It amends parallel authorities in the Public Health Service Act, ERISA, and the Internal Revenue Code to add per‑individual penalties for specified violations and to expand penalties tied to Independent Dispute Resolution (IDR) outcomes.
Beyond straight fines, the bill forces repayment when an IDR decision finds a lower payment than an initial out‑of‑network payment, imposes a 30‑day repayment deadline, and levies a triple‑difference penalty plus interest for late or non‑payment. It also tightens transparency by requiring coordinated, semiannual reports to five Congressional committees with audit counts, complaint tallies, penalties collected, non‑monetary corrective actions, and the top three violations.
For compliance officers, benefits managers, and provider finance teams, the bill turns routine surprise‑billing disputes into events with significant financial exposure and new reporting obligations.
At a Glance
What It Does
The bill amends PHSA, ERISA, and the Internal Revenue Code to (1) raise certain per‑day fines to a new per‑individual civil penalty of up to $10,000 for enumerated No Surprises Act violations, (2) require repayment by nonparticipating providers when an IDR determination is lower than an initial payment and set a 30‑day deadline, and (3) impose a three‑times difference penalty (plus interest) for late or nonpayment after an IDR decision. It also mandates semiannual, cross‑agency reporting to specific Congressional committees.
Who It Affects
Group health plans and health insurance issuers offering group coverage; nonparticipating providers and facilities (including air ambulance providers explicitly called out); employers that sponsor group plans; and federal enforcement agencies (HHS, DOL, Treasury) that must coordinate audits, notifications, and expanded reporting.
Why It Matters
The bill materially raises the financial downside of noncompliance with balance‑billing rules and the IDR process, changing incentives for both plans and providers. It adds predictable reporting and transparency to enforcement activity—information that will shape future compliance priorities, litigation risk, and operational changes in claims and billing workflows.
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What This Bill Actually Does
HB 4710 is a targeted enforcement package for the No Surprises Act. It amends the enforcement provisions across three statutory regimes—PHSA, ERISA, and the Internal Revenue Code—so that the same substantive balance‑billing protections are backed by higher civil penalties.
For certain specified balance‑billing provisions the bill replaces modest per‑day penalty language with an express statutory ceiling of $10,000 for each individual harmed by a violation, and it inserts parallel penalty authority into ERISA enforcement provisions.
The bill also changes how payments tied to Independent Dispute Resolution (IDR) outcomes are handled. If an IDR determination awards a payment that is less than the initial out‑of‑network payment made (after accounting for the patient’s cost‑sharing), the nonparticipating provider or facility must return the excess to the plan or coverage within 30 days of the determination.
If either the plan/coverage or the nonparticipating provider fails to make required payments in the required timeframe, the statute requires the delinquent party—whether plan or provider—to pay an additional remedy equal to three times the difference between the initial payment (or $0 if the plan denied payment initially) and the out‑of‑network rate established under the statute, less patient cost‑sharing; amounts due under that remedy also accrue interest to be specified by the Secretary.To support oversight, the bill expands and regularizes public‑facing reporting. It directs HHS (working with Labor and Treasury where applicable) to provide semiannual reports to specified House and Senate committees, starting the first February 1 after enactment, containing counts of audits and complaints, enforcement actions, aggregate civil monetary penalties, summaries of non‑monetary corrective actions, and the three most common violations.
The bill also contains transitional language requiring an initial reporting period that captures audits back to 2022 through the date of enactment. Practically, the package forces operational changes—claims reconciliation to capture repayment obligations, stronger audit trails for payments and IDR files, new notification filings with federal agencies when payments are made, and tighter coordination among regulators.
The Five Things You Need to Know
For enumerated No Surprises Act provisions, the bill replaces the prior ‘‘$100 per day’’ penalty language with an express statutory ceiling of $10,000 for each individual affected by the violation.
ERISA enforcement receives a new subsection (502(c)(12)) authorizing the Secretary to assess civil penalties of up to $10,000 per individual against group health plans or issuers that violate specified balance‑billing provisions.
If an IDR determination is lower than the initial out‑of‑network payment (after patient cost‑sharing), the nonparticipating provider or facility must repay the difference to the plan or coverage within 30 days of the determination.
If a plan, issuer or nonparticipating provider fails to make a required payment after an IDR decision, the delinquent party must pay three times the difference between the initial payment (or $0 on denial) and the statutory out‑of‑network rate (less patient cost‑sharing), and that penalty accrues interest as set by the Secretary.
The bill requires coordinated semiannual reporting (to House Ways & Means, Energy & Commerce, Education & Workforce and Senate Finance and HELP) listing audit counts, audits begun under prior triggers, provider and enrollee complaints, enforcement actions, aggregate penalties, summaries of corrective actions, and the three most common violations.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Designates the measure the "No Surprises Act Enforcement Act." This is purely nominal but signals the bill's narrow focus on enforcement mechanics rather than substantive changes to coverage rules.
Adds per‑individual $10,000 penalty authority for specified balance‑billing violations
The bill amends PHSA section 2723(b)(2)(C), IRC section 4980D(b), and inserts new ERISA penalty authority at 502(c)(12) to provide a $10,000‑per‑individual maximum civil penalty for failures tied to specific subsections of the No Surprises Act (the bill enumerates the exact statutory provisions covered). In PHSA and the Code the text replaces the prior ‘‘$100 per day’’ posture for those specified provisions with the $10,000 ceiling language; in ERISA it creates a parallel remedy so that enforcement parity exists across the three enforcement regimes. Practically, this provision raises the ceiling on exposure for cases where many individuals are affected and makes coordinated enforcement by HHS, DOL, and Treasury more consequential for violators.
Repayment duty, 30‑day deadline, and triple‑difference penalty for late/nonpayment after IDR
This section amends the payment‑timing subsections that govern IDR outcomes (PHSA 2799A–1(c)(6) and 2799A–2(b)(6); ERISA 716(c)(6) and 717(b)(6); IRC 9816(c)(6) and 9817(b)(6)). It imposes three linked obligations: (1) if the IDR determination is less than the initial payment plus any patient cost‑sharing, the nonparticipating provider/facility must remit the excess to the plan within 30 days; (2) the party that fails to make a required payment (plan or provider) must pay an additional amount equal to three times the difference between the initial payment (or $0 on an initial denial) and the out‑of‑network rate defined in the statute (net of patient cost‑sharing); and (3) any such amounts are subject to interest as specified by the Secretary. The amendments also require that when the required payments are made, the payer submit a notification to the Secretary in a form the agency will prescribe. That combination imposes both a reconciliation obligation on providers and a strong monetary deterrent for late payment by either side.
Explicitly extends the same repayment and penalty rules to air ambulance claims
The bill repeats the timing, repayment, notification, and late‑payment penalty language within the air ambulance subsections of the statutes (PHSA 2799A–2, ERISA 717, IRC 9817). Because air ambulance billing has been a frequent source of No Surprises Act disputes, the text makes clear that the 30‑day repayment obligation and the triple‑difference sanction apply to air ambulance services as well, removing any argument that those costly transports are outside the enhanced enforcement regime.
Semiannual transparency reporting to Congress and data elements required
This section tightens reporting to Congress. Under the amended PHSA and Code provisions, HHS (and Treasury for Code duties), coordinating with the Departments of Labor and Treasury/HHS as appropriate, must provide semiannual reports to named House and Senate committees beginning the first February 1 after enactment. The reports must include the total number of audits, audits begun under certain prior clauses, counts of provider and enrollee complaints, enforcement actions triggered by complaints, the number and aggregate dollar value of civil monetary penalties assessed, a summary of non‑monetary corrective actions taken against plans/issuers, and the three most commonly reported violations. The bill also contains an initial reporting directive covering audits back to 2022 through the enactment year.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Insured individuals receiving care: stronger enforcement and a repayment obligation reduce the risk they face of unexpected balance bills after an IDR decision and improve chances that excess provider charges are returned to plans rather than borne by patients.
- Compliant plans and issuers: plans that follow the rules gain a stronger statutory deterrent against providers that overbill or fail to reconcile IDR outcomes, improving predictability of network and out‑of‑network cost exposure.
- Federal regulators (HHS, DOL, Treasury): clearer statutory penalty authority and mandatory reporting produce better visibility into noncompliance patterns and provide data needed to prioritize audits and enforcement.
- Nonparticipating providers who follow statutory billing practices: these providers benefit indirectly because the package increases consequences for peers who bill aggressively or ignore IDR findings, reducing freeloading behavior that distorts negotiations.
Who Bears the Cost
- Nonparticipating providers and facilities, including air ambulance operators: they face a new repayment duty, 30‑day deadline, potential triple‑difference penalties plus interest for late/nonpayment, and the administrative cost of notifications to the Secretary.
- Group health plans and issuers: although often on the beneficiary side of disputes, plans can also be liable for triple penalties if they fail to make required payments; plans will need tighter claims workflows, reconciliation rules, and reserves for potential penalties.
- Small physician practices and rural providers: these entities may have limited cash flow to absorb repayments or treble damages, elevating financial risk and potentially prompting changes to where or whether they provide out‑of‑network services.
- Federal agencies: HHS, DOL and Treasury must coordinate audits, process additional notifications, and produce semiannual reports—workload increases that entail administrative expense and the need for new data systems or guidance.
Key Issues
The Core Tension
The central dilemma is between deterrence and distortion: the bill increases penalties and repayment obligations to deter balance‑billing abuse and encourage compliance, but those same penalties can push providers to avoid out‑of‑network care or raise prices upfront, shifting costs or access burdens onto patients and complicating the marketplace in ways enforcement alone cannot easily fix.
The bill sharpens enforcement but leaves implementation details to agency rulemaking and interagency coordination. Key elements—how the Secretary will calculate interest, the reporting formats and timelines for notifications, and precisely how the out‑of‑network rate formula will interact with initial payments—are delegated.
That creates immediate uncertainty for plan and provider finance teams who must comply quickly but cannot yet know the administrative mechanics or timing of enforcement actions.
There are also distributional and behavioral tradeoffs. A statutory treble‑difference penalty deters bad actors but risks overdeterrence: providers may refuse out‑of‑network care, raise initial demands to hedge repayment/penalty risk, or shift charges into other billing avenues.
Conversely, plans may accelerate aggressive denials to limit initial payments (which could increase patient appeals and IDR volume). Finally, the bill presumes effective cross‑agency coordination; without adequate staffing, guidance, and IT systems, the semiannual reporting and notification regime could produce delays, inconsistent enforcement, or litigation over statutory interpretation—especially around terms like ‘‘initial payment,’’ ‘‘out‑of‑network rate,’’ and what constitutes timely payment.
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