When Dr. Noah Spencer retires from private practice to accept a job offer from his longtime friend and protege, Steve Nesbitt, Noah can't begin to imagine what's ahead. In his new position as medical director of Salyer Medical Center, Noah discovers shocking irregularities in the hospital's quality-management reporting. And he finds Steve's indifferent attitude toward below-standard performance to be unusual and disturbing.
Unbeknownst to Noah, Steve has been fighting a losing battle with addiction. Steve becomes deeply indebted to a Mafia-owned casino and attempts to climb out of his cash-shortage quandary by accepting kickbacks. The fact that he is blatantly betraying his hospital weighs heavily on Steve's mind. When he is pressured by the Mafia to participate in a money-laundering scheme, he decides to break his ties with them. Now privy to the illicit operation of the Mafia, Steve becomes a target for silencing.
Although he cannot unravel the details, Noah has a strong suspicion that a link exists between Steve's gambling problems and the quality issues at the hospital. Eager to help, Noah and his wife become embroiled in a sequence of events with Steve and his wife that threatens to entangle them in the FBI's testosterone-driven investigation of a corrupt underworld organization.