We tend to assume that if something feels wrong in healthcare-like getting charged thousands out of nowhere or having a doctor you’ve never met show up mid-surgery; it’s probably illegal. But that’s not always the case. The U.S. medical system isn’t just complicated. It’s shaped by outdated laws, patchy regulations, and powerful industry lobbying. So a lot of medical practices that sound like they should be banned? Still completely legal. That’s especially true when ethics and legality start to drift apart. What this really means is that even people who stay on top of their health can get blindsided. Here are ten practices you probably thought were outlawed; but aren’t.
1. Surprise Billing After ER Visits
You show up to an in-network ER and assume your insurance has it covered. Then comes a massive bill because one of the doctors or specialists wasn’t actually in-network. This kind of surprise billing used to be common, and while the No Surprises Act (2022) blocked a lot of it, loopholes remain. The law doesn’t apply to ground ambulances, and enforcement depends on how well states back it up. Some providers also push the limits by using vague paperwork or fine print. The takeaway: you can still get hit with unexpected charges even when you do everything right. Legal? Yes. Fair? That’s debatable.
2. Unregulated Dietary Supplements
You can walk into any pharmacy and buy a supplement promising better memory, sleep, or weight loss. And none of them are required to prove they work; or that they’re safe-before hitting shelves. Thanks to the Dietary Supplement Health and Education Act of 1994, supplements bypass the kind of FDA review that prescription drugs face. The result is a $50 billion industry with little oversight. Some products contain unlisted ingredients, questionable dosages, or interact badly with medications. Unless enough people get hurt and file reports, the FDA usually doesn’t step in. It’s all legal. You’re just expected to figure out what’s safe on your own.
3. Paying Doctors to Promote Drugs
Pharmaceutical companies are still allowed to pay doctors to promote medications, attend sponsored dinners, or give branded talks. It’s legal, as long as payments are disclosed through the Open Payments database. But let’s be real; most patients don’t sift through spreadsheets before a checkup. Even when the intentions are clean, the incentives blur the lines between medical advice and marketing. And while some hospitals limit these relationships, the practice isn’t banned at a national level. This means your doctor’s recommendation could be partly shaped by their ties to a drug company. Legal? Yes. Transparent? Not unless you know where to look.
4. Forced Sterilization of People With Disabilities
This one’s deeply uncomfortable, but it’s still happening. Several U.S. states still allow guardians or courts to authorize sterilization for individuals with disabilities, often without full consent. These laws vary by state, and while the practice is less common than it used to be, it hasn’t been fully banned nationwide. Many trace this back to eugenics-era policies that were never entirely dismantled. Today, advocates are still fighting to strengthen protections around informed consent and bodily autonomy. Bottom line: forced sterilization of disabled individuals is still legal in parts of the country. Most people have no idea it’s not already outlawed.
5. Using Expired or Re-Sterilized Medical Devices
Hospitals are allowed to reprocess and reuse certain single-use medical devices, and even use ones that are technically expired. This usually happens under internal protocols and is more common in resource-limited settings or with non-critical tools. The FDA does allow third-party reprocessors, but oversight can be thin. If a hospital says the item is still sterile and functional, it may get used again. Patients typically aren’t told unless there’s a problem later. While this can help control costs, it raises questions about safety, especially when supply chains are stressed. It’s legal, and it’s happening, even if most people don’t realize it.
6. Physical Restraints in Psychiatric Care
Restraints-whether belts, cuffs, or locked chairs; are still legally used in psychiatric hospitals, nursing homes, and youth treatment centers. Federal rules require they only be used when medically necessary and under supervision. But in practice, enforcement varies widely. Some facilities use restraints too quickly or too often, especially when staff are undertrained or under pressure. Abuse cases still happen, and deaths have occurred from improper use. For many, the idea that someone could be physically restrained without clear consent sounds like something from the past. But it’s not banned. It’s still legal-and still controversial-in American mental healthcare.
7. Withholding Hospital Infection Data
You’d think infection rates at hospitals would be easy to find. They’re not. While the CDC and CMS track some hospital-acquired infections, not all are publicly reported. In some states, hospitals aren’t required to disclose infection data to patients. And even when data exists, it’s often buried in government dashboards or available only in bulk reports. The result is that you can check into a hospital without knowing how often patients there get preventable infections. That lack of transparency is legal, even if it feels like something that should’ve changed by now. And it puts the burden on patients to dig deep for answers.
8. Facility Fees at Clinics
Facility fees are extra charges added on top of what you pay for a regular doctor’s visit-just because the clinic is affiliated with a hospital system. You might go in expecting a $100 appointment, then get a bill for hundreds more. These fees are legal in many states and don’t always have to be disclosed upfront. They’re becoming more common as hospitals buy out independent clinics. Even if you don’t use hospital equipment or services, you’re often charged as if you did. Most people assume this kind of fee would be illegal or at least flagged clearly. But it’s not.
9. Practicing Without Malpractice Insurance
Some states don’t require doctors to carry malpractice insurance. That means if something goes wrong and you try to sue, you may not be able to collect damages-because there’s no policy to pay out. This is more common in fields like cosmetic surgery or boutique practices where doctors operate independently. While many still choose to carry coverage, they’re not always legally obligated to. The idea that a surgeon could perform risky procedures without any financial safety net for patients is alarming. But again, it’s legal in several states. It’s just not something you’ll see advertised in the waiting room.
10. Ghost Surgeries
In some teaching hospitals, the surgeon you meet before a procedure might not be the one doing it. Residents, assistants, or even other surgeons may step in-sometimes without your explicit knowledge. This is legal under certain informed consent policies, but the definition of “informed” gets blurry. Unless the consent form clearly spells out who will be performing what, patients can be left in the dark. Academic medical centers argue it’s part of training the next generation. But patients often assume the surgeon they consulted with will be hands-on. In reality, someone else may be holding the scalpel. And that’s still legal.