Open and Unashamed in an Era of Consumer Protection: Unconscionable Hospital Billing Practices and the Chargemaster Racket

Abstract

This article examines strategic legal efforts made by uninsured plaintiffs attempting to hold hospitals accountable for excessively high health care costs. Although recent legislation has made chargemaster rates more transparent, more consumer protection action is needed. Openly sharing exorbitant rates defeats racketeering charges and fraud claims, but is unlikely to impact the actual cost of care. Patients should not be expected to negotiate major medical bills as if they are making a regular consumer purchase. The article identifies recent state and federal case law permitting unconscionability claims to proceed against hospitals and health systems, and the need to protect patients by applying a fiduciary duty in the context of medical billing.

Keywords: unconscionability, hospital, medical, billing, chargemaster, bankruptcy, fiduciary, cost of care