That's not how health insurance works - at least the US. Insurance companies reimburse either on a fee-for-service model, in which the hospital is paid for eve

That's not how health insurance works - at least the US. Insurance companies reimburse either on a fee-for-service model, in which the hospital is paid for every procedure they do (with no cap); or bundle style model (capitation or diagnosis-related group), where the hospital is paid a flat fee, regardless of what procedures they might do. So while there are maximum quotas in the bundle style model, you actually make if you do fewer procedures, not if you do more. > Why bother investigating further, simply do the procedure and write-off the patient. eg. tonsillectomy, many other -ctomies. Because the insurance company will audit the medical chart and deny payment for the surgery if they deem the surgery to have been inappropriate. There is a huge incentive for them to do this - $500 dollars of audit time on their end could save them $10,000 or more if they end up denying payment. It actually much more profitable for the hospital to exactly the opposite of what you suggest - only do a surgery if they are 99% sure that the insurer will pay for it in full. This is one of the biggest sources of health care inequality in the US. Poor people are more likely to have cheap insurance that has a high rate of denying payment. Profitable hospitals don't want to risk nonpayment, so they will decline to do expensive surgeries on these patients and instead refer them to county hospitals or safety-net hospitals that operate at a loss and generally have poorer quality facilities and longer wait times.