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Question - has anyone ever heard of any enforcement of this provision by any agency? 

It's been well established that there is no private cause of action to enforce it. I can't find that HHS has ever taken any action to enforce it. In theory, being out of compliance with it could trigger the excise tax under IRC 4980D, but does anyone know if the IRS has ever sought that? I cannot find any IRS guidance on it.

Has there been any consequence for failing to remove exclusions of certain types of provider, for self-insured health plans?  There are basically no court cases about this other than ones dismissing private actions.

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