This legislation, titled the "No Surprises Act Enforcement Act," aims to strengthen compliance with existing balance billing protections. It does so by increasing penalties for violations by group health plans and health insurance issuers. The bill amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986 to achieve these enforcement goals. A key provision significantly increases civil monetary penalties for specific balance billing infractions. For certain failures, the penalty shifts from $100 per day to a substantial $10,000 for each failure , targeting violations of critical consumer protections against surprise medical bills. This change applies to a range of provisions related to out-of-network services and cost-sharing. The bill also introduces new, stringent penalties for non-compliance with Independent Dispute Resolution (IDR) payment determinations. If a plan, coverage, non-participating provider, or facility fails to make a required payment within 30 days after an IDR determination, they must pay an additional amount. This penalty is set at three times the difference between the initial payment (or zero if denied) and the final out-of-network rate, plus interest, applying to both emergency/nonemergency services and air ambulance services. Finally, the legislation enhances transparency and oversight by modifying reporting requirements for federal agencies. It mandates semi-annual reports to Congress on audits, complaints, and enforcement actions related to the No Surprises Act. These reports must include details on the number of audits, complaints from providers and consumers, enforcement actions taken, total civil monetary penalties, non-monetary corrective actions, and the three most common violations, thereby increasing accountability for all parties involved.