This is 100% the case, the billing side is completely and absolutely disconnected from the care side it's not even funny. As long as the inflows from customers and insurances companies roughly equal the outflows in expenses, they really don't care much how everything is billed.

Which is why you can often do better paying cash at a "expensive" hospital that is overflowing with money than at a "budget" one that is having difficulty making the numbers balance. The latter is more likely to hard-line.