Still, it seems worthwhile to work towards penalizing hospitals for routinely going over the line, otherwise they will continue to monetize the difference between what is right and what they can get away with.

And on that front, I still have to ask how it's not straightforward fraud to lie about the expenses incurred? If we're roommates and I pick you up a gallon of milk at the store knowing you want some and will reimburse me, but I add it to our tab as $20 - am I not attempting to defraud you?

Trumped up costs do routinely happen across all sectors. It just seems on this topic that grassroots pushback is never discussed, yet could be quite appropriate. For example, a self-help form letter that demands an "out of network" hospital substantiate exactly why their expenses were double that of every other hospital.

It is fraud. It's just not prosecuted, because it's a wealthy corporation doing it.