These are not new laws, having been on the books in essentially the same form for more than 20 years. Yet government inspectors have recently found billions of dollars of fraud in business arrangements that violate these laws, and many shocked medical care practitioners have found themselves the subjects of criminal investigation. The reality is that medical care practitioners and institutions have been in denial about the importance of the laws, a denial made possible because the federal government did little enforcement of the laws until about 1994. For comparison, consider the imaginative tax schemes that business would engage in if the Internal Revenue Service stopped enforcing the tax laws for 20 years.