patient, assuming that the clinical decisions made solely focus on patient health. However, a physician's behavior may also be influenced by their desired income level. The current system is oriented towards fee for service, punishing lower utilization and rewarding overutilization through increased revenue. Physicians may use their knowledge differential and influence over patients to increase utilization of imaging or screening services, given the potential financial rewards. The behaviors seen in supplier induced demand in healthcare have contributed to our current overuse of imaging and diagnostic tests, which has resulted in an upward spiraling of medical costs projected to equal 20% of our GDP by 2015. The advent of newer technology has not only led to improvements in care, but also to potentially unnecessary screening and diagnostic testing possibly influenced by financial incentives to referring physicians, practice behavior of referring physicians, US health system, comparative effectiveness research, appropriateness criteria, and quality gaps in evidence-based care. It has been suggested that fragmented care processes, imperfect patient memory, and lack of electronic medical records also contribute to the overutilization of imaging services. As a result, imaging services and physicians' reliance on these technologies have increased at a dramatically higher rate than other technologies. Advancements in imaging have broadened their application, increasing uptake. For instance, positron-emission technology (PET) is now used in oncology and degenerative diseases of the central nervous system. Similarly, overutilization is evidenced in the promotion of CT scans for private offices. As physician owned surgical centers and specialty hospitals increasingly use imaging services, insurers question the cost benefit ratio of the technology. Data also suggests that physicians tend to refer well insured patients to physician owned facilities, while referring Medicaid patients to hospital outpatient clinics, thus financial incentives to self-refer to physician owned facilities may affect the referral patterns of less financially beneficial patients. As pointed out in one case, it is difficult to identify this type of overutilization "fraud". In the high-profile case of Dr. Mark Midei, he inserted cardiac stents in over 500 patients whose artery occlusion rates did not warrant surgical intervention according to standards of care. The hospital Dr. Midei practiced at agreed to pay $22 million fine to settle charges. Another cardiologist in Louisiana was sentenced to 10 years in prison, convicted on 51 counts of billing private and government health insurers for unnecessarily implanting cardiac stents, and the hospital he practiced at was forced to