I happen to know of a specialized medical practice where it is possible that people are being misdiagnosed with a disorder that the practice profits on cheating.

In at least some cases, it's possible the patients are being taken care of, because the diagnostic criteria are not in line with more recent evidence that what was considered subclinical before is actually a health issue that ought to be treated.

In other cases, it may be that patients are being prescribed a medical treatment that they don't need, or having expensive tests ordered that are unnecessary, in order to generate profit.

Now, interestingly enough, this medical treatment is almost certainly harmless to those without illness, even if inconvenient.

To add to this, practice is in a more rural area, such that it may be the only such treatment facility available in their area.

So, I have a bit of a moral dilemma which is an interesting case of what your quote indicates:

This practice benefits large numbers of people, and employs a number of workers who are not complicit in the act, and whose work is specialized enough that they would probably be forced to move elsewhere if the practice closed down-- in some cases from the community they've lived in for decades.

And again, it's highly likely that the patients who may be receiving superfluous treatments or diagnostics are completely unharmed by them, with essentially zero probability that it will ever be a harmful.

If this is occurring, most of the patients are paying essentially nothing out of pocket, or very little. (Though some with poor insurance are a different story.)

So there is a quandary: if reported, and true, the licensing authority in that area of medecine will almost certainly shut down the clinic (because the doctor would probably have his own licensing, which is separate from the clinic licensing, revoked-- and no doctor, no clinic. )

That would possibly remove a lot of people from receiving potentially life-saving care. In addition, it would forcibly unemploy many honesty employees-- the vast majority of the practice-- some of whom will not be able to find equivalent work or afford a move, and leave the community they call their home.

On the other hand, defrauding an insurance company or an individual patient by changing certain numbers to qualify them for treatment-- what I suspect happens on occasion -- and stealing their money by lying to them is clearly a terrible ethics violation, one to be taken very seriously, and which should be punished. (And, if described, they would immediately demand an investigation.)

So, does one allow the minor defraudment to continue, because on the whole more people benefit, and greatly, from this practice continuing to exist, even if it continues to defraud?

Or-- as Kant would advise -- should no question of expediency or utility be allowed to report such a thing?