At the headquarters of Boston's Eastern Quality Health, the wealthy and powerful CEO is brutally murdered. She's not the first to die - nor the last. A vicious serial killer is on the loose and the victims have one thing in common: they are all high-profile executives in the managed care industry.

Dr. Will Grant is an overworked and highly dedicated surgeon. He has experienced firsthand the outrages of a system that cares more about the bottom line than about the life-and-death issues of patients. As a member of the Hippocrates Society, Will seeks to reclaim the profession of medicine from the hundreds of companies profiting wildly by controlling the decisions that affect the delivery of care. But the doctor's determination has attracted a dangerous zealot who will stop at nothing to make Will his ally. Soon Will is both a suspect and a victim, a pawn in a deadly endgame. Then, in one horrible moment, Will's professional and personal worlds are destroyed and his very life placed in peril.

Rookie detective Patty Moriarity is in danger of being removed from her first big case - the managed care killings. To save her career, she has no choice but to risk trusting Will, knowing he may well be the killer she is hunting. Together they have little to go on except the knowledge that the assassin is vengeful, cunning, ruthless - and may not be working alone. That - and a cryptic message that grows longer with each murder: a message Grant and Moriarity must decipher if they don't want to be the next victims.