Can a hospital system mutate ? If the system is not generating enough dollars, might there be a temptation to?

I am not sure I follow your question entirely, but I can tell you this, as long as there is the threat of million dollar lawsuits, the hospitals don't like to get too fancy with bending rules. All it takes is one screw up and the hospital will find itself paying millions to someone Any money they might save from playing little tricks like the ones you described, would be completely undone by a single 10 million dollar lawsuit, not to mention that if someone died and it was proven that it happened on purpose, that is called murder. In that event someone would be going to jail for a long time.