The overbilling largely is caused by hospitals that are trying to recoup the growing costs of indigent care. As a result, people who are financially strapped are subject to aggressive debt collectors.
"We're talking about people who don't have insurance because either they never had it, can't afford it, they've lost it," said Rep. Jim Greenwood, chairman of the House Energy and Commerce subcommittee on oversight and investigations.
"An average working man or woman treated at a hospital can be stuck with a bill that is double what managed care or government programs pay," said Greenwood, R-Pa. "Then, to add insult to injury, they are sometimes aggressively pursued for these inflated debts. This situation is unfair and unjust."
Hospital executives said the cash crunch would best be solved through universal health care coverage for Americans. An estimated 43 million Americans have no health insurance.
Hospitals in the Philadelphia area, for example, charged an average of $30,000 to treat a heart attack in 2002, said Dr. Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University. He said most insurers ultimately were asked to pay less than $10,000.
Hospitals now charge uninsured patients twice to four times as much for treatment as patients with health care coverage, he said.
Until recently, many hospitals refused to offer discount programs or otherwise let patients negotiate their bills, fearing that doing so would violate federal fraud and abuse laws.
But the Health and Human Services Department clarified its guidelines this year to "clearly enable hospitals and others to help patients who are experiencing financial hardship," said Lewis Morris, chief counsel to the agency's inspector general.
But the heads of several national hospital systems pleaded for help, saying they were trying to treat as many uninsured patients as possible and deal with corporate financial problems.
At Ascension Health, one of the largest nonprofit Catholic hospital systems, every one of its hospitals lost money last year on the services provided to the uninsured, and bill collectors pursued payment from between 5 percent to 10 percent of those patients, said the president and chief executive, Anthony R. Tersigni.
He urged Congress to enact universal health care as a necessary effort greater "than any one hospital system can undertake."