Medicine is absolutely chock full of loopholes and practices that allow the devious, underhanded, unethical and profit-seeking to do well. They do not always do well, but they often do. They cherry-pick patient populations, they maximize high-revenue patient populations or procedures. If you open a small window, someone will drive a truck through it. This is in part because you can typically only prove fraud in the aggregate, not in individual cases. Individual cases can always be justified. If you order 6 immunos on every lung tumor biopsy, that isn't justified. But if you pick any one case out of there, it is easy to justify. If a urology practice biopsies 50% more patients than a comparable practice, that isn't justified. But if you pick out any individual excessive biopsy case, you can find a reason to justify it. If you order UroVysion FISH on every urine, that isn't justified. But every individual case can probably have some justification.