Government Healthcare: Codes That Kill

By:  Richard Fleming, M.D.
07/17/2013
       
Government Healthcare: Codes That Kill

The U.S. government is using its payment system to control the types of medical treatment Americans get, leading to high medical costs and high mortality.

The Association of American Physicians and Surgeons (AAPS) recently published several articles telling the story of cardiovascular surgeon John Natale, M.D., who is in prison after being accused of attempting to defraud Medicare. On November 1, 2012, Natale began a 10-month prison sentence, though at trial a jury found him innocent on all charges of fraud.

Here’s his story: Between August 2002 and October 2004, Dr. Natale operated on five seriously ill elderly patients, averaging 78 years old. All the patients lived through the surgery, “despite an expected mortality of 90 percent.” The 63-year-old Natale, who “routinely worked from 5:30 a.m. until late at night,” was “habitually … behind in dictating his operative reports” and when he filled out the reports weeks after the surgeries, he incorrectly stated that he repaired an aortic aneurysm instead of the type of aneurysm he actually repaired. He was accused of using an incorrect American Medical Association code — a code the government requires doctors use for billing — to bill the government for the procedure he performed, though there is no precise AMA code for the procedure he did.

The charges against Natale were the result of a seven-year government investigation into his records, wherein the government reviewed 2,400 operative reports. Natale’s defense rested upon his claims that he simply made some reporting errors and that there was no fraud because if he had billed the government properly, he actually would have received more money for his services than he actually received. The jury agreed and found him not guilty on all fraud charges. But Natale was imprisoned anyway for making “false statements” in his operative reports, though under the law, according to AAPS, “a false statement is a crime only if made in a deliberate attempt to commit fraud — and, as the jury determined, there was no fraud.” (Emphasis in original.) He was literally imprisoned for making minor errors — if politicians, judges, prosecutors, and Medicare workers were held to the same standard, it would be safe to say that nearly every one of them would be in prison.

The harsh sentence meted out to Natale was evidently meant to intimidate doctors. Prosecutor Amarjeet Singh Bhachu flatly stated: “A message needs to be sent out to doctors.” Yet it could have been worse. Because Natale had the gall to actually defend himself at trial and testify in his own defense, the prosecutor asked for a sentence enhancement for “obstruction of justice,” which “could have resulted in 5 years in prison.” No kidding.

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