This bill strengthens enforcement of the No Surprises Act, which protects patients from unexpected medical bills when they receive care from out-of-network providers. The legislation increases penalties for health plans and insurers that violate balance billing rules, raising certain penalties from $100 to $10,000 per violation for specific breaches. Additionally, the bill imposes substantial new penalties on plans and insurers that fail to pay providers on time after an independent dispute resolution determination—requiring them to pay three times the difference between their initial payment and the correct out-of-network rate, plus interest. The bill also establishes new transparency requirements, mandating that federal agencies submit detailed reports to Congress every six months beginning after the bill's enactment, documenting audits conducted, complaints received, enforcement actions taken, and patterns of violations. These changes aim to discourage non-compliance with balance billing protections and increase accountability among health plans and insurance companies.