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

(Photo by JOSEPH PREZIOSO/AFP via Getty Images)

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.” (RELATED: Soaring Health Care Costs Might Just Tip Scales In Crucial Midterms, Analysts Say)

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........

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