Well, first off it's not a "single, isolated requirements out of context." From TFA >in exchange for implementing clinical decision support (CDS) alerts in it

Well, first off it's not a "single, isolated requirements out of context." From TFA >in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products. When and how the software would display the CDS alerts would be discussed in a planning meeting; the logic of each individual CDS alerts would not, those would be handed down from somewhere else. Software engineers are in no position to be suggesting or discussing individual clinical decisions. Software engineers aren't going into a planning meeting saying "hey, what about suggesting scheduling a pap test if the patient is a female between 21 and 60 and there's no record of a recent test?" That's not in the software engineer's purview. So there's very little doubt in my mind that the "suggest opioids if XYZ" CDS alert came down in a list of other innocent CDS alerts like "suggest pap test if XYZ" or "suggest mammogram if XYZ" or "possible drug interaction detected" or "tetanus vaccine due." Of course there's also the possibility that the system was engineered so that the person configuring the software builds all the CDS alerts themselves with a drag-and-drop interface. But anyway, sometimes you, as an engineer implementing the system, don't get to personally participate in requirements gathering, planning meetings, or interfacing with the end users. Depending on a lot of factors, sometimes that's done by pointy haired bosses at a much higher level. Especially if you're just a contractor or a subcontractor. I once worked on a project as a short term subcontractor (around six months), I was literally handed detailed requirements, including mockups of all the screens, and told "implement this." Of course, everyone had their own opinion on how it should work, but it was not open for discussion. So I have absolutely no reason to believe that the programmers of this software knew about this nefarious kickback scheme but I have reason to believe that they probably didn't.