The problem seems much less simple than people just "taking it".
The first line of defense against these shenanigans is provider choice. If you've got employer insurance, you have no choice. If you are unemployed or have the kind of poorly paying job that has no insurance, you must prioritize one of a few cheap plans, all of which have bad reputations. The number of people who can really choose is likely quite small.
The second line of defense is knowledge of your rights. However... these rights are quite squishy. The insurance company has quite a number of methods, and people trained in using them, for creating and assigning debts. The customer typically has no knowledge, no time to obtain that knowledge, and nowhere to turn for help. Most people also know that if they're in a situation like yours, the company can very quickly make it MUCH worse by sending the imaginary debt on to a collector; this may be "illegal" but that's a nasty swamp to dive into for a regular person with time constraints.
The third line is just... persistence. This is most accessible, but you're probably underestimating the number of people who either flat out don't have the time / mental bandwidth for it, or have a fear of going against authority which more or less prevents them from repeatedly pushing back.
The insurance industry is an evolved parasite, and it has taken its current form after decades of evolutionary pressure in the system. You may not believe that people should "take it", but it is nevertheless specifically evolved to have the maximum number of ordinary people do exactly that.
I do know why the fraud succeeds so much of the time, and I agree your comment does a good job of explaining many of the dynamics. I really meant my lead in more in the context of why relatively informed people discussing this on message boards and in news articles brush past having paid fraudulent bills in such fatalistic terms, rather than stating they were bullied/tricked or they consciously decided it wasn't worth their time to fight. It lends an air of legitimacy to the shakedowns.
I had a durable medical equipment supplier send me a fully "adjusted" and paid by "insurance" bill that I had already paid the correct copay on, but they were still demanding more. I double checked with the "insurance" company, then called the supplier and told them how their bill was wrong. They responded with some nonsense like "that is their price, this is our price. Don't you want to pay what you owe?". I asked them if they liked referrals to the attorney general and they just flat out hung up on me. Never heard another word. These people are shameless.
The first line of defense against these shenanigans is provider choice. If you've got employer insurance, you have no choice. If you are unemployed or have the kind of poorly paying job that has no insurance, you must prioritize one of a few cheap plans, all of which have bad reputations. The number of people who can really choose is likely quite small.
The second line of defense is knowledge of your rights. However... these rights are quite squishy. The insurance company has quite a number of methods, and people trained in using them, for creating and assigning debts. The customer typically has no knowledge, no time to obtain that knowledge, and nowhere to turn for help. Most people also know that if they're in a situation like yours, the company can very quickly make it MUCH worse by sending the imaginary debt on to a collector; this may be "illegal" but that's a nasty swamp to dive into for a regular person with time constraints.
The third line is just... persistence. This is most accessible, but you're probably underestimating the number of people who either flat out don't have the time / mental bandwidth for it, or have a fear of going against authority which more or less prevents them from repeatedly pushing back.
The insurance industry is an evolved parasite, and it has taken its current form after decades of evolutionary pressure in the system. You may not believe that people should "take it", but it is nevertheless specifically evolved to have the maximum number of ordinary people do exactly that.