Surgeon Reports to Prison; Government Sends Message

Dec 11, 2012

On Nov 1, 2012 vascular surgeon John Natale, M.D., 63, of Arlington, Ill., reported to the federal Bureau of Prisons to serve a 10-month sentence.

According to a U.S. Department of Justice press release, he was convicted on two counts of making false statements in connection with surgeries performed between August 2002 and October 2004, and acquitted on two counts of Medicare fraud.

Dr. Natale had saved the lives of five seriously ill patients, average age 78, by complicated repairs of abdominal aortic aneurysms. He was, however, accused of describing the procedures as more complex than they actually were, supposedly in order to collect more payment.

According to the transcript of the sentencing proceedings, U.S. Attorney Amarjeet Singh Bhachu emphasized that “The need for deterrence is very strong in a case like this…. A message needs to be sent out to doctors.” The government aimed not just to end a distinguished medical career but to imprison the doctor for as long as possible.

“The message doctors will receive,” stated Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, “is that the government has declared war on doctors. Making a mistake in two of 2,400 operative reports is apparently now a federal crime, even though the doctor’s total charges were much less than he could have lawfully billed.”

Physicians are required to use AMA-copyrighted codes in their billings. These codes are frequently changed or added to, and Natale testified that he had been taught at seminars to pick the most similar code if there wasn’t one precisely matching the procedure.

The doctor admitted that there were a few unintentional errors in some operative reports. Judge Rebecca Pallmeyer stated: “It’s hard for me to imagine that there was some motivation other than to pad the bill in Dr. Natale’s operative notes.”

Because Dr. Natale testified on his own behalf and gave a lengthy explanation of the reasons for the mistakes, the prosecution demanded a sentencing enhancement for obstruction of justice. This could have resulted in 5 years in prison.

The government was also concerned that the doctor did not accept responsibility for his guilt. Not only did he insist on going to trial: the prosecutor stated that “my sense is, still today, that the doctor doesn’t really believe he actually committed an offense.”

Dr. Orient stated that “after this case, doctors may believe that their government will treat them like criminals, despite an outpouring of support from their grateful patients. Many may decide that continued participation in Medicare is far too dangerous.”

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943.