The inauguration of the Medicaid program in the mid 1960s ultimately led to the appearance of a wide range of new forms of illegal behavior by physicians. The fact that government authorities, instead of individual patients, were responsible for payments undoubtedly encouraged the large number of violations. A review of the background of sanctioned physicians shows an overrepresentation of psychiatrists and foreign medical graduates as well as minority-group physicians. Interviews with physicians sanctioned for Medicaid fraud and abuse indicated that they routinely placed the blame for their violations on the program, their employees, patients, or others. In particular, they find program guidelines confusing and irrational and insist that they intrude on what ought to be independent medical judgments. The enforcers, for their part, maintain that the convicted physicians are merely rationalizing self-serving and greedy behavior.