Jay, good column, but you are just scratching the surface. A few quick facts from my time in Medicare's hospital enforcement area: Maryland physicians do a poor job of self-policing; Medicare contracts with state agencies which are supposed to protect the public by enforcing Medicare hospital health and safety rules; JCAHO is an accreditation organization not part of any enforcement process; Maryland hospitals have a unique reimbursement arrangement with Medicare (different then any other state); and politically, the Maryland state agency has no incentive to strictly enforce Medicare hospital health and safety rules. Your best chance to survive a Maryland hospital admission is to be admitted on the first day of a 5-day JCAHO inspection because the hospital will be spotless, all equipment will be operative, and all hospital staff are required to be present and responsive. The stent investigation will likey fall through the cracks because the hospital can legally deny direct responsibility and they have a financial incentive to do so because physician groups supply their patients, the State will not be helpful, and physicians will of course "lawyer up". Dig deeper.

Jay,

State and national authorities have a piss-poor track record at successfully regulating squat. How did the SEC do preventing the dot-com bubble & bust? How about Congress and its oversight of Fannie-Mae? What about the Federal Reserve and the Treasury and their inability to see a housing bubble and mortgage scandal happening in plain view?

As long as "other peoples' money" is being spent "other peoples" will be all that will care about fraud and waste. If you believe otherwise I have a securitized mortgage bond of prime beach front property to sell you.