I think you are implying the following when you say "you have to look at the government": "if you want to fix the problem of people/clinics/etc. abusing (dodging/fraudulently take advantage of) government programs/policies you have to ..." ----- And the "..." is not filled in. I guess I could fill it in with: "stop implementing policies/programs if you are not at the same time investing as much as it is necessary to guarantee nobody gets around the law" - that is, do not trust, add more inefficiency (clinics already need to attest the procedure is necessary) and cost.