The loophole may be something called insurance or Medicare fraud. Perhaps a discreet inquiry to insurance companies and/or the federal regulators may be in order.
I know that many insurance companies audit physicians/hospitals, etc. to check that they collect the deductibles. Thinking is if the doc doesn't collect deductibles, perhaps the insurance company is paying too much for the procedure or office visit ... I don't think you have to collect 100% of deductibles, but it had better be a high percentage, preferably at the point of service or serious attempts to collect by billing, etc.