The hospital thing is standard practice in the US. The Canadian hospitals likely have to lie to get reasonable payouts from US insurance companies.

For instance, I once needed $600 of tests at the ER. The hospital billed $80K. The insurance company paid $7K. I paid $100.

Sure, the $600 does not include the ER overhead, but the $7K was still insanely inflated. The important thing is that the money ultimately came from insurance premiums, so every middleman was able to reliably extort all patients.