JUNE 17, 2026

Physician calls on Congress to crack down on hospital billing abuses including upcoding and facility fees

A House Ways and Means Committee hearing recently called the CEOs of several major U.S. health systems to testify about hospital billing practices. When committee Chairman Jason Smith (R-MO) asked the executives to raise their hands in support of legislation to equalize payments for patients, none did. The hearing examined practices such as facility fees and upcoding, which critics say inflate patient costs beyond the actual cost of care.

A physician and healthcare executive writing in the Washington Examiner argued that hospital billing practices in the United States have become systematically disconnected from the actual costs of delivering care, calling on Congress to mandate auditing and hold corporate health systems accountable.

The op-ed pointed to two practices it described as especially widespread. The first is "facility fees," which occur when a hospital system acquires an independent doctor's office, makes no changes to the care provided, and begins attaching additional charges to every bill. The second is "upcoding," in which a patient's diagnosis or visit is coded at a higher severity level than warranted in order to trigger a larger insurance payout. The author cited billing data showing that most emergency department visits are now coded at the highest severity levels — Category 3, 4, or 5 CPT codes — even for minor conditions such as a sprained ankle or simple stitches.

The piece stated that an estimated 10% to 15% of all healthcare claims are abusive, and attributed rising insurance premiums and out-of-pocket deductibles in part to inflated billing that insurers pass on to businesses and families. It also noted that hospital consolidation over the past two decades has resulted in one or two corporate systems controlling care access in roughly half of U.S. metropolitan regions, which the author connected to higher patient prices and lower wages for workers.