The systems meant to watch doctors are basically designed to ignore patients getting hurt unless there’s a paperwork error or a financial crime.
March 25, 2026
Original Paper
Compliance Silence: How Healthcare Oversight Responds to Harm Without Breaking the Law
SSRN · 6188178
The Takeaway
We assume that health regulators exist to protect patients from bad care, but this paper introduces 'Compliance Silence Theory' to show the opposite. It reveals that oversight agencies are optimized to catch billing fraud while remaining 'legally inert' toward actual human suffering, effectively documenting harm without having the legal mandate to stop it.
From the abstract
Despite extensive regulatory infrastructure, U.S. healthcare oversight systems con nue to tolerate significant pa ent harm without correc ve ac on. While agencies rou nely detect criminal misconduct, billing fraud, and sen nel events, they remain largely unresponsive to cumula ve, non-criminal harm arising from delayed care, dismissive treatment, documenta on minimiza on, and ins tu onal nonresponse. These harms dispropor onately affect Black pa ents but also extend broadly to other marginalized