JAMES CARTER: Hospitals Pick Your Pocket, And Washington Lets Them

Every year, American families sit down to review their health insurance and brace for the same gut punch: premiums rising, deductibles higher, out-of-pocket maximums climbing. Most accept it as an unavoidable fact of life. It doesn’t have to be this way.

A large share of those rising costs comes from something that can be fixed: hospitals and large health systems exploiting opaque pricing, inflating bills, and using consolidation to squash competition. Call it what it is: fraud when providers bill for care not delivered, and waste and abuse when the system rewards higher codes and higher facility fees for the same care. It’s time conservatives demand accountability.

Let’s start with the billing games. Hospitals are increasingly coding patient visits as more medically complex than they really are, a practice known as upcoding, or “coding intensity.”

A recent analysis of Blue Cross Blue Shield claims from 2022 to 2025 found that the top 10 percent of hospitals drove the vast majority of detected increases in complexity coding. By early 2025, those high-growth facilities were coding about 60 percent of eligible inpatient admissions as “complex.” The study estimated this added roughly $22 million in excess maternity spending alone over the period. That money doesn’t appear out of nowhere—it comes from your premiums.

Then there are the facility fees and site-of-care markups. Get a routine test in a doctor’s office, and you pay one price. Get the exact same service in a hospital outpatient setting, or in a clinic that looks like a doctor’s office but is owned and billed like a hospital, and you can pay multiples more. The service is identical; the bill is not.

The Committee for a Responsible Federal Budget found that the same echocardiogram costs three times more in a hospital outpatient setting than in a physician’s office. Drug infusions can cost 3.2 times more