I'm sure the overbilling and weaponized opaqueness are plausibly deniable, but I'm just as sure that providers don't mind one bit when they work, just as an insurance company doesn't mind when they discover an excuse to deny coverage. Providers are not "making ends meet," they are testing the limits of how far they can exploit the blank checks they have been written. They are not solely responsible for this mess, but they have a full share of moral and systemic culpability.