Healthcare
Costs Facts
This page is a running, sourced record of fraud, waste, abuse, and price manipulation in U.S. healthcare. This behavior matters because it drives higher premiums and out-of-pocket costs for Americans.
What can you do?
Sign up, share, and help push accountability.
Pricing
The Problem: Healthcare prices are inconsistent, resulting in patients and employers paying wildly different prices for the same service.
Why It Raises Costs or Harms Patients: Hidden prices break down competition, pushing up premiums and out-of-pocket costs and leading patients to skip out on the care they need because they can’t afford it.
What Accountability Looks Like: We must demand greater transparency on prices, an end to “surprise” billing practices, and payment models that reward outcomes instead of a provider’s leverage.
Supporting Articles:
- · Wide disparities found in hospitals' drug prices
- · How Hospitals are Raising Drug Prices
- · Report: Hospital drug prices can vary up to 2,000x across country
Fraud
The Problem: Intentional deception in healthcare billing and more can lead to paying for services that were not necessary or were never provided at all.
Why It Raises Costs or Harms Patients: Fraud drains resources from those who really need care, drives costs up for everyone through higher premiums and taxes, and puts patients at risk when unneeded services are pushed to generate profit.
What Accountability Looks Like: Meaningful penalties will deter repeat offenders, faster detection will limit the fraud’s reach, and strong protections for whistleblowers will encourage others to speak out against it.
Supporting Articles:
- Surgical group and hospital pay $12.76M to settle allegations of improper relationships with two physician groups
- Medical device manufacturer settles improper billing allegations
- Marketer pleads guilty to $7.8M durable medical equipment fraud and kickback scheme
- Home healthcare and hospice provider, Intrepid, ordered to pay $3.85M to settle false claims
- Durable medical equipment company owner pleads guilty to scheme to defraud Medicare of $39.5M
- Denver-based durable medical equipment company biller charged with $1.2M in false Medicaid claims
- Ohio woman arrested for $1.5M Medicaid fraud
- Boston electronic health records vendor ordered to pay $18.25M to resolve kickback allegations
- Tennessee woman accused of selling fake weight-loss drugs
- Kindred at Home ordered to pay $19.4M to settle false claims and overpayments allegations
- Louisiana physician convicted for illegally distributing 1.8M opioids and more than $5.4M in fraud
- Massachusetts home health company owner convicted in $100M Medicaid fraud scheme
- Ohio physician sentenced to 26 months for $8M of Medicare fraud
- Montana physician pleads guilty to $39M Medicare telehealth fraud
- Home health company settles Medicaid fraud allegations for nearly $1M
- CityMD settles $12M COVID test fraud suit
- Las Vegas physician convicted in $2M Medicare and Medicaid fraud scheme
- Michigan physician convicted for role in $6.3M Medicare fraud scheme
- Kentucky physician sentenced to two years for role in $14M kickback scheme
- Houston physician to pay $1.8M to settle Medicare false claim allegations
- Florida pharmacy owner guilty in $36.2M Medicare fraud scheme
- Florida couple convicted for $125M worth of fraudulent Medicare and Tricare claims
- Florida compounding pharmacy CEO sentenced for role in $40M Tricare fraud scheme
- Washington physician pleads guilty in Medicare and Tricare fraudulent telemarketing and medical supply scheme
- Ohio pharmacy owner convicted for dispensing gastroenterology drugs without prescriptions and overcharging Medicaid $2.3M
- New York physician indicted for involvement in $20.7M worth of false claims in Medicare and Medicaid
- Illinois physician convicted of $1.2M in Medicaid fraud
- Washington physician pays settlement to resolve allegations he ordered medically unnecessary durable medical equipment
- President of pharmacies in New Jersey pleads guilty to $32M worth of Medicare and Tricare fraud charges
- Ohio physician convicted for $1.5M of Medicaid fraud
- Washington durable medical equipment supply company owner settles fraud case
- Guardant Health settles false Medicare and Tricare claims allegations
- Medical marketer convicted and ordered to pay $59M in restitution for defrauding Tricare and other federal health programs
- Florida medical supply company owner arrested for submitting false Medicare claims exceeding $17M
- Philadelphia pharmacy owners to pay $4.6M for submitting false claims to Medicare and Medicaid
- St. Louis home health company owner accused of defrauding Missouri's Medicaid program out of more than $3M for over a decade
- Texas hospital pays $14.2M to settle anti-kickback, Medicare violations
- Texas medical supplier sentenced for defrauding Medicare and Medicaid for $1.7M
- Shuttered healthcare-sharing ministry co-founder convicted for $8M fraud scheme in Missouri
- Texas lab owner charged in $79M Medicare and Medicaid fraud scheme
- Michigan home health owner sentenced for $7.9M Medicare fraud
- Michigan home health owner sentenced to nine years for $2.8M Medicare fraud
- QOL Medical and its CEO to pay $47M to settle anti-kickback allegations
- Pomona Valley Hospital Medical Center in California to pay $2M to settle 340B overbilling allegations in Medicaid
- New York medical billing operator sentenced to 12 years and ordered to pay $336M for billing fraud
- California lab owner sentenced to ten years for $234M worth of Medicare fraud
- California hospice physician convicted for his role in a $2.8M Medicare fraud scheme
- Former Cardiac Imaging executive charged for anti-kickback violations
- Mental health services administrator in Washington, DC sentenced to five years in prison and ordered to pay more than $4.45M for Medicaid fraud
- New Jersey seized $6.4M worth of assets from the estate of deceased owner of mental health clinics for thousands of false Medicaid claims
- Catheter billing scam could be costing Medicare $2B
- Owner of Chicago-based durable medical equipment pharmacy, Symed, sentenced to prison for $87M kickback scheme
- Florida lab owner convicted for defrauding Medicare out of $30M in fraudulent COVID test claims
- California marketing company owner charged in fraud and kickback scheme that cost Medicare more than $10M
- New York medical billing company owner pleads guilty to submitting false claims
- Idaho clinic chain ordered to pay $2M to settle fraud allegations
- Former leaders of Arkansas medical supply business sentenced to prison and ordered to pay more than $5M for fraud and kickbacks
- South Carolina owner of at least ten durable medical equipment companies sentenced to prison for one of the "largest Medicare fraud schemes in history"
- Massachusetts owner of home health company, Arbor Homecare Services, convicted in $100M fraud scheme
- Three labs agreed to pay $2.45M to settle allegations of manipulating codes in claims submitted to Medicare and Medicaid
- California lab agrees to pay $1M for double-billing Medicare for urine drug testing
- Skilled Nursing Facility operator, Grand Healthcare System, pays $21.3M for billing federal healthcare programs for services that were unreasonable, unnecessary, unskilled, or didn't occur
- New Orleans hospice owner sentenced to 20 years for defrauding Medicare $84M
- Louisiana hospice owner sentenced to six years and ordered to pay more than $3.6M for healthcare fraud
- Mississippi man with connections to pharmacies, durable medical equipment companies, and laboratories, pleaded guilty for role in $51M Medicare scheme
- Illinois lab owner charged in $60M Medicare COVID testing scheme
- California sleep clinic owner sentenced for submitting $1.5M in fraudulent claims to Medicare and Medicaid
- Penn Highlands Healthcare in Pennsylvania to pay $735K to settle whistleblower suit alleging self-referral violations
- Owners of New York transportation company plead guilty to $2.1M in Medicaid fraud and kickbacks
- Tennessee outpatient clinic to pay more $1.1M to settle improper billing allegations
- Managers of Chicago mental health center sentenced for defrauding Illinois' Medicaid program of $2.5M
- Chicago nurse practitioner group pays $2M to settle upcoding allegations in Medicare and Medicaid
- Medical device CEO sentenced to six years for selling fake chronic pain devices implanted in patients
- Teva Pharmaceuticals to pay $425M to resolve kickback allegations
Waste & Abuse
The Problem: Hospitals spend money in ways that do not improve health outcomes, including duplicative services that do not meet the legal definition of fraud, but inflate costs and undermine trust.
Why It Raises Costs or Harms Patients: Waste and abuse add cost without adding value, which can harm patients through overtreatment and other avoidable complications.
What Accountability Looks Like: We need incentives for care that works and consequences for patterns of overuse, as well as clear safeguards that reduce low-value care.
Supporting Articles:
- 600K patients in Washington State received $282M in unnecessary treatment
- Whistleblower suit filed against MultiCare Health in Washington for medically unnecessary spinal surgeries
- Kentucky lab to pay $10.5M to settle allegations of unnecessary testing in Medicare and Medicaid
- Telemedicine company owner guilty in $110M medically unnecessary durable medical equipment scheme
- National durable medical equipment company to pay $25.5M for continuing to bill federal health programs for equipment no longer used or needed
- Florida call center owner indicted in durable medical equipment kickback scheme costing Medicare $97M
Providers & Networks
The Problem: Provider networks can be shaped in ways that limit competition, reducing patients’ in-network options and forcing employers to accept higher prices to keep “must-have” providers in the network.
Why It Raises Costs or Harms Patients: Narrow or unstable networks disrupt continuity of care, steer patients into higher-cost settings, and create surprise out-of-network bills.
What Accountability Looks Like: Clear, straightforward network information combined with strong oversight of anti-competitive practices will allow patients to confirm coverage before care and protect them from out-of-network traps.
Supporting Articles:
- New York medical practice pays $600K to settle allegations of services billed by providers not enrolled in Medicare and Medicaid
- Tennessee-based Erlanger Health System faces federal lawsuit alleging it overpaid physicians for improper referrals
- Texas radiology group fined $8.8M for illegal referrals
Billing & Claims
The Problem: Complex billing and claims systems lead to confusing patient statements that make it hard to tell what services were provided, what was covered, and what a patient owes.
Why It Raises Costs or Harms Patients: Billing complexity drives waste and creates financial stress for patients who may receive unexpected bills and spend hours disputing errors.
What Accountability Looks Like: Simple, standardized billing will better explain charges, leading to more transparent claims so patients and payers alike can correct errors faster.
Supporting Articles:
- Registered Nurse and Nurse Practitioner in Rhode Island sentenced for $12M in fraudulent billing scheme
- Two California physicians ordered to pay more than $2.4M for kickbacks
- The University of Washington and other public hospitals routinely settle medical malpractice cases with NDAs. Some legal experts say that needs to stop.
- Former pharmacy owner sentence for role in $11.5M Medicaid fraud scheme
- New York physician pleaded guilty for ordering medically unnecessary brain scans
- New Jersey cardiologists sentenced to nearly 3 years for $1.9M in fraudulent claims
- Michigan pharmacist and brother convicted in $15M billing scheme
- Tennessee pharmacy owners indicted for $8.7M in fraud
- Texas physician gets 10 years in prison for $54M Medicare fraud
- New York doctor pleads guilty to $900K fraud scheme
- Arizona physician sentenced to 2 years for $3.7M in fraud
- Dallas pharmacy owner convicted in $41M fraud scheme
- Hospital upcoding is big business
- Study: Upcoding associated with $14.6B in hospital payments in 2019
- Penn State Health ordered to pay $11.7M to resolve allegations of improper Medicare billing
- New York-Presbyterian Hospital agreed to $800K fine for improper radiology billing
- Cape Cod Hospital paid $24.3M to settle claims it had violated Medicare reimbursement protocols in whistleblower case
- Oroville Hospital in California paid $10.25M to settle kickbacks and false billing allegations
- San Diego physician and medical practice pay $3.8M to settle false claim allegations
- San Diego neurosurgeon charged in $100M insurance fraud case
- 2 charged in $54M Medicare fraud scheme in California
- Louisiana physician indicted in $32.7M Medicare billing scheme
- Texas behavioral health provider indicted for $2M Medicaid fraud
- Delaware physician agrees to pay $1M to settle allegations of ordering medically unnecessary durable medical equipment
- CEO of Massachusetts-based behavioral health company pleads guilty to fraud
- Louisiana lab CFO sentenced for $127M Medicare fraud scheme
- California physician sentenced for $2.8M Medicare fraud scheme
- Montana-based St. Peter's Health to pay $10.8M to resolve false claims for oncology services
- Ohio physician sentenced for defrauding Medicare and Tricare for $14.6M
- Connecticut therapist pleads guilty to $1.6M in Medicaid fraud
- Kentucky physician sentenced to two years in $14M fraud conviction
- California physician pleads guilty to $3.2M Medicare fraud
- Texas behavioral health providers pay $1.1M to settle Medicare false claims charges
- University of Colorado Health agrees to pay $23M to settle upcoding allegations
- Alaska physician and husband charged with $10M in fraud and tax evasion
- Former Georgia Insurance Commissioner sentenced to more than 3 years for billing insurers over $2.5M in false claims
- Illinois physician pleads guilty to fraud
- Tennessee podiatrist sentenced for defrauding Medicare and Medicaid $4M in reimbursements
- Two New York pharmacy owners sentenced to 14 collective years in $18M Medicare laundering case
- Baylor agrees to pay $15M to settle concurrent billing allegations
- Texas physician convicted in $70M fraud scheme
- Illinois physician sentenced to eight years for more than $1.2M in Medicaid fraud
- California pharmacist sentenced to two years for billing more than $1M in fraudulent claims
- Alabama physician and wife plead guilty to $2.3M fraud scheme
- Massachusetts psychiatrist sentenced in $19M Medicare and insurance fraud scheme
- Twin physicians plead guilty to defrauding payers millions in fraudulent billing
- Massachusetts orthopedic surgeon convicted for role in upcoding scheme
- Arizona physician pleads guilty to $3.7M fraud scheme
- New York/New Jersey pharmacy leaders admit to defrauding payers more than $65M
- Former clinic owner in California convicted for submitting more than $5M in fraudulent claims
- New Jersey counseling center owner pleads guilty to billing insurers for services never provided
- Houston pharmacy CEO convicted for fraudulently billing payers $160M for expensive topical creams
Big Hospitals
The Problem: Through consolidation and market dominance, hospitals can limit competition, demand higher prices, and make accountability hard to enforce.
Why It Raises Costs or Harms Patients: When local competition is reduced, patients have little choice other than to pay higher prices despite no real improvements in quality of care.
What Accountability Looks Like: With clear reporting on ownership, pricing, and outcomes, the value of consolidation will be clear to patients, employers, and policymakers, allowing better enforcement of pricing rules.
Supporting Articles:
- · The states where hospitals are most concentrated
- · Rise of Hospital Monopolies Causing ‘Elevated Concerns’ of ‘Increased Prices …’
- · Rising health care costs continue to erode the American standard of living
Cost of Care
The Problem: It’s not just “what” was provided, but “how” as well, and too often the system rewards the volume of treatment instead of the quality of the care, including prevention and effective management.
Why It Raises Costs or Harms Patients: High cost-sharing can discourage preventive care and early treatment, making health outcomes worse and costs higher over time.
What Accountability Looks Like: Measurements that focus on outcomes and chronic disease management will allow patients and employers to identify high-quality care for themselves.
Supporting Articles:
- · National Health Care Spending Increased 7.2 Percent In 2024 As Utilization Remained Elevated
- · One-Third of Americans Cut Back to Cover Healthcare Expenses
- · Health Care Costs and Affordability