Enforcement

Enforcement

To help inform policymakers as they debate a range of patient protection options, we have identified key considerations for addressing surprise medical bills. These considerations are informed by policies already adopted in 28 states and the proposals under consideration in Congress. One key consideration is how surprise medical billing protections will be enforced.

Enforcement

Policymakers should also consider how the government will ensure that insurers and providers comply with surprise billing protections. One key issue is whether it is easier for the state or federal government to enforce the rules and which state or federal agency is best positioned to conduct enforcement. Some states direct their insurance department to ensure compliance with the law, but while insurance departments have clear jurisdiction over insurance companies, they often lack jurisdiction over providers. Some states may rely on their medical licensing authority or “deceptive trade practice” statutes to enforce requirements on providers; other states may be dependent on the attorney general filing a civil lawsuit against providers who continue to send surprise bills to patients.


We Are Here to Help

Our goal is to help policymakers adopt comprehensive surprise billing protections for patients. Policymakers and staff can contact our team about a specific question or with a broader request for technical assistance. Our experts are available to review materials and consult on policy solutions.