[TheOtherHobbes]

IANAL, but I suspect it's deceptive if the changes were deliberately hidden and there is no notification of them.

For example - if someone agreed a contract, changes are made, and they were pressured to sign without reading the document.

If changes are flagged and/or highlighted it would stand a reasonable chance of being valid. Likewise if the patient sent a cover email/letter saying "This is my standard contract."

Because these exchanges are bureaucratic, it's quite likely the changes wouldn't be noted - or might possibly be automated.

It could be argued that's a failure of diligence by the hospital rather than fraud.

And it's also clearly unconscionable to expect patients to sign a literal blank check with an open amount without anything resembling a credible estimate. That's simply unenforceable.

All of this underlines why single-payer is the only viable system. Without it a few people get extremely rich with huge financial and social costs to everyone else - which is not freedom, it's forced tribute and subsidy.