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Two facts are unarguable about crimes and other violations by physicians of the regulations that control the practice of medicine under the Medicaid and Medicare programs. The first is that there are considerable physical and fiscal harms; the second is that few who break the laws are apprehended, prosecuted, or convicted. The reasons for this situation provide the core material of the present paper; in this regard it provides detailed and specific case study material on a subject often addressed in general terms in the literature on white-collar crime: why it is that the perpetrators of upper-class offenses so readily avoid the stipulated legal consequences of their actions (Ross, 1907; Sutherland, 1934; Geis, 1967; Katz, 1979; Hagan and Parker 1985). The illegal behavior by physicians participating in the Medicare and Medicaid programs offers special advantages for analyzing the punishment of white-collar offenders. Most importantly, physicians allow for the study of individual versus group, or corporate behavior. Recent studies of white collar crime have tended to see individual behavior within the context of corporate enterprise. Organizations are viewed as amalgamates of inter changeable operating personnel who behave on the basis of institutionalize requirements (Ermann and Lundman, 1982). Within the camouflage of the organization the individual is usually protected from sanctioning. As Braithwaite has noted,“[N] either the political will nor the prosecutorial resource exist to prove beyond a reasonable doubt that complex activities of a large company constitute a crime”(1981-82: 482). That the situation Braithwaite describes for corporations …