Some of it is accidental. A lot of it is poor systems design, antique or nonexistent computer systems, and poor management. The best and brightest administrators generally go to jobs in which they can get stock options, not into health care. There are plenty of smart providers in hospitals. CEO's-not so much. And some of it is because most of the revenue comes through contracts with insurers who negotiate a flat rate for a diagnosis- so, no matter what the actual product and service charges are for my fractured femur, my insurance company pays the hospital $4500 each for me and for each of the 20 other insured fractured femur patients cared for that calendar quarter. Tends to reduce the amount of attention paid to getting the charges right on any individual patient. Like most things, it is probably not a conspiracy of criminal geniuses-more like a three stooges comedy with stethoscopes.