dividual receiving such item or serv-
ice). 
‘‘(ii) INTEREST.—Any amount owed 
under clause (i) shall be subject to interest 
in a manner specified by the Secretary.’’. 
(c) IRC.— 
(1) EMERGENCY
AND
NONEMERGENCY
SERV-
ICES.—Section 9816(c)(6) of the Internal Revenue 
Code of 1986 is amended— 
(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
(B) by striking ‘‘The total plan’’ and in-
serting the following: 
‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; 
(C) in subparagraph (A), as so inserted, by 
adding at the end the following new sentence: 
‘‘In the case such determination is an amount 
less than the sum of the initial payment for 
such item or service and any cost sharing re-
quired to be paid by the individual receiving 
such item or service, the nonparticipating pro-
vider or facility furnishing such item or service 
shall pay to such plan the difference between 
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such determination and such sum not later than 
30 days after the date on which such deter-
mination is made.’’; and 
(D) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan, or a nonparticipating provider or facility, 
required to make a payment pursuant to a de-
termination described in subparagraph (A), 
such plan or nonparticipating provider or facil-
ity shall submit to the Secretary a notification 
of such payment as of the date such payment 
is made in a manner specified by the Secretary. 
‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
‘‘(i) IN GENERAL.—In the case of a 
plan, or a nonparticipating provider or fa-
cility, that has not made the required pay-
ment described in subparagraph (A) with 
respect to an item or service in the time 
period described in such subparagraph, in 
addition to making such payment, such 
plan or nonparticipating provider or facil-
ity shall also pay to the nonparticipating 
provider or facility or plan (as applicable) 
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an amount that is three times the dif-
ference between— 
‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(1)(C)(iv)(I) or (b)(1)(C), as appli-
cable; and 
‘‘(II) the out-of-network rate (as 
defined in subsection (a)(3)(K)) for 
such item or service (less any cost 
sharing required to be paid by the in-
dividual receiving such item or serv-
ice). 
‘‘(ii) INTEREST.—Any amount owed 
under clause (i) shall be subject to interest 
in a manner specified by the Secretary.’’. 
(2) 
AIR
AMBULANCE
SERVICES.—Section 
9817(b)(6) of the Internal Revenue Code of 1986 is 
amended— 
(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
(B) by striking ‘‘The total plan’’ and in-
serting the following: 
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‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; 
(C) in subparagraph (A), as so inserted, by 
adding at the end the following new sentence: 
‘‘In the case such determination is an amount 
less than the sum of the initial payment for 
such item or service and any cost sharing re-
quired to be paid by the individual receiving 
such item or service, the nonparticipating pro-
vider or facility furnishing such item or service 
shall pay to such plan the difference between 
such determination and such sum not later than 
30 days after the date on which such deter-
mination is made.’’; and 
(D) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan, or a nonparticipating provider or facility, 
required to make a payment pursuant to a de-
termination described in subparagraph (A), 
such plan or nonparticipating provider or facil-
ity shall submit to the Secretary a notification 
of such payment as of the date such payment 
is made in a manner specified by the Secretary. 
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‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
‘‘(i) IN GENERAL.—In the case of a 
plan, or a nonparticipating provider or fa-
cility, that has not made the required pay-
ment described in subparagraph (A) with 
respect to an item or service in the time 
period described in such subparagraph, in 
addition to making such payment, such 
plan or nonparticipating provider or facil-
ity shall also pay to the nonparticipating 
provider or facility or plan (as applicable) 
an amount that is three times the dif-
ference between— 
‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(3)(A); and 
‘‘(II) the out-of-network rate (as 
defined in section 9816(a)(3)(K)) for 
such item or service (less any cost 
sharing required to be paid by the in-
dividual receiving such item or serv-
ice). 
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‘‘(ii) INTEREST.—Any amount owed 
under clause (i) shall be subject to interest 
in a manner specified by the Secretary.’’. 
SEC. 4. TRANSPARENCY REPORTING REQUIREMENTS. 
(a) PHSA.—Section 2799A–1(a)(2)(A)(iii) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
300gg– 
111(a)(2)(A)(iii)) is amended to read as follows: 
‘‘(iii) REPORTING.— 
‘‘(I) INITIAL
REPORTING.—Be-
ginning for 2022 and ending on De-
cember 31 of the calendar year in 
which the Enhanced Enforcement of 
Health Coverage Act is enacted, the 
Secretary shall annually submit to 
Congress a report on the number of 
plans and issuers with respect to 
which audits were conducted during 
such year pursuant to this subpara-
graph. 
‘‘(II) 
SUBSEQUENT
REPORT-
ING.— 
‘‘(aa) IN
GENERAL.—With 
respect to the first calendar year 
following the date of the enact-
ment of the Enhanced Enforce-
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ment of Health Coverage Act, 
not later than February 1 of 
such year, and every 6 months 
thereafter, the Secretary, in co-
ordination with the Secretary of 
Labor and the Secretary of the 
Treasury, shall submit to the 
Committee on Ways and Means, 
the Committee on Energy and 
Commerce, and the Committee 
on Education and Workforce of 
the House of Representatives, 
and the Committee on Finance 
and the Committee on Health, 
Education, Labor and Pensions 
of the Senate, a report on any 
audits conducted pursuant to this 
subparagraph during the applica-
ble reporting period, and any en-
forcement actions taken during 
such period in accordance with 
the provisions of this part, in-
cluding— 
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