Unscrupulous Choices by James A. Sesnak (Book Review #2207)

James A. Sesnak’s Unscrupulous Choices is a chilling and emotionally complex work of historical crime fiction, rooted in reality and driven by the human consequences of greed. Inspired by the 2023 CNBC segment “Fraud in a Bottle,” the novel peels back the layers of corruption in America’s healthcare system, laying bare a criminal enterprise that’s as plausible as it is horrifying.

At the heart of this story are two brothers—Elijah Lee, a brilliant high school valedictorian, and Treyvon, a street-smart drug dealer in South Central L.A. Despite their opposite trajectories, the brothers find common ground in an illicit scheme involving a morally bankrupt pharmacist in Compton. Together, they exploit vulnerable HIV-positive heroin users, repurposing life-saving medications for profit while billing insurance companies thousands for tainted drugs. The novel’s tension ratchets up with the inclusion of a clinic insider who leaks patient information, and a series of burglaries that leave already struggling victims devastated.

Among those victims is Ada Thatcher, a woman whose story becomes the soul of the novel. A survivor of sexual abuse at an elite Catholic school, Ada contracted HIV under harrowing circumstances that remained hidden for years. When her antiretroviral medication is stolen, her past resurfaces in a torrent of trauma and hard truths. As Ada’s story unfolds, it becomes a powerful commentary on survival, accountability, and the systemic failures that allow corruption to thrive.

Sesnak’s writing is raw and uncompromising. His decades-long career in the medical field lends the novel an authenticity that’s difficult to fake—each scene feels clinically accurate yet emotionally visceral. The gritty underworld of healthcare fraud, paired with the human cost of its victims, evokes comparisons to Breaking Bad and the journalistic depth of Spotlight. Yet this story stands uniquely on its own, fueled by personal insight, moral urgency, and a deep empathy for its characters.

With Unscrupulous Choices, Sesnak proves himself not only a knowledgeable insider but also a compelling storyteller. This is crime fiction with heart, laced with social commentary, tragedy, and a call for justice. Readers looking for a suspenseful, character-driven narrative that isn’t afraid to tackle real-world issues will find this book hard to put down.

Highly recommended for fans of gritty crime fiction, medical drama, and socially conscious storytelling.

Written by Jeyran Main

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