The healthcare landscape is changing with the depressed economic times we have encountered in the United States. The anticipated Medicare cutbacks have created angst among physicians and healthcare institutions. This case is a clear reminder to individual physicians and medical institutions that when faced with potential future payment cutbacks and a changing and uncertain financial landscape for the U.S. healthcare system, the overriding responsibilities of physicians and medical institutions must always be for the medical welfare of patients and exercising proper fiduciary responsibility.