The billion-dollar health scam lawmakers refuse to shut down

Americans aren’t stupid. Polls show that only 18% have a favorable view of the pharmaceutical industry, while 60% hold a negative opinion. Though hospitals fare better, their rating is also declining — and it’s no wonder.

Recent reporting from the Guardian has shed light on the predatory tactics used by monopoly hospitals like Parkview Health in Indiana. These institutions exploit patients when they are most vulnerable, charging exorbitant prices with little oversight or accountability.

Banning prior authorization could cost patients and taxpayers billions of dollars.

Rising health care costs are affecting hundreds of Hoosiers. In his 2025 State of the State address, Gov. Mike Braun acknowledged that many families worry about affording necessary medical care. Meanwhile, the reasons behind the relentless price increases have remained unclear — until now.

News reports reveal that regional hospitals have tapped into what they see as “unlimited dollars” by pushing unnecessary, high-cost treatments. These findings help explain why health care prices continue to spiral out of control.

Health care’s dirtiest secret

A heroic whistleblower — a former doctor — has revealed one of the health care industry’s dirtiest secrets: Doctors regularly prescribe invasive surgeries for minor issues to secure bigger bonuses. “Somebody comes in with knee arthritis and basically they’re having pain, but they haven’t had any other treatment,” he told the Guardian. “These guys will jump right to a knee replacement surgery.”

Another Parkview employee, an office manager who worked in the system for over a decade, explained why doctors would do such a thing: “The more you code, the higher you code, the more credit you get, which would translate to bonuses.”

This is unacceptable. Hoosier doctors are penalized for choosing safer, lower-cost options over the highest-cost ones — even if they’re harmful to patients — just to pad Parkview’s $1.66 billion in reserves.

This pattern isn’t limited to surgeries. Research shows that 34% of older adults are prescribed potentially inappropriate drugs, which can pose serious health risks and needlessly drive up costs.

Demand prior authorization

Fortunately, prior authorization serves as a critical safeguard against unnecessary and costly medical treatments. This process requires doctors to submit clinical information to a patient’s insurance company before approving expensive or unusual procedures and medications. By rejecting inappropriate requests, insurers help protect patients from unnecessary care and prevent billions of dollars in wasted health care spending.

Some Indiana lawmakers want to ban or severely limit prior authorization despite its benefits. But the state legislature has no reason to hinder or dilute this critical patient protection from the health care industry’s dirty money-making scheme.

While doctors may find prior authorization paperwork frustrating, it plays a vital role in preventing waste, fraud, and abuse — problems that plague the health care system. An estimated 25% of all health care spending, roughly $935 billion annually, is wasted. Eliminating prior authorization in private insurance could saddle Hoosier patients and taxpayers with billions in unnecessary costs, placing an even greater financial burden on working families and small businesses.

A national issue

Indiana is already experiencing a $1 billion Medicaid shortfall. The state cannot afford an additional $6 billion in health care costs over the next decade by banning prior authorization. Yet the legislature is still considering it.

The Indiana Senate Appropriations Committee has advanced a bill to limit the use of prior authorization in state health plans, but key provisions were stripped from the original proposal due to fiscal concerns.

This problem extends beyond Indiana. Lawmakers nationwide should focus on real solutions to our health care crisis rather than handing out favors to bad actors. Hospitals should be incentivized to serve their communities, not enabled to exploit them.