Dr. Jane Orient, executive director and standard bearer of the Association of American Physicians and Surgeons (and killer of Clintoncare and on the trail of Obamacare) sent me the following:

Association of American Physicians and Surgeons

1601 N. Tucson Blvd. Suite 9

Tucson, AZ 85716

(800) 635-1196



Nov. 2, 2012


Contact: Jane M. Orient, M.D., (520) 323-3110, janeorientmd@gmail.com


Surgeon Reports to Prison; Government Sends Message, States AAPS


Tucson, Ariz. According to the Association of American Physicians and Surgeons, 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.”

Unfortunately, this case is not unique.  Keep this physician’s fate in mind as you read the following advertisement for a webinar to help physicians stay out of trouble with Mediscare:

Good Morning,
The Complexity Of The Medicare Rules For “Incident To” Billing Is Continued As You Look At Other Insurance Payers. Non-physician Practitioners (NPP) are being utilized in more and more practice situations to help ease the workload and allow for expansion of the practice. Many practices have taken an “all or nothing” approach to NPP reimbursements: billing all services directly or all services “incident to”.  Neither of these is correct. The supervision of NPP’s has seen numerous comments and clarifications from the OPPS in the past 3 years. The impact of this information should not be viewed negatively. The concept of “Split shared visits” is relatively easy to understand but the practical use and documentation requirements become the challenge. Non-physician Practitioners (NPP) reimbursement & billing rules are variable.
Join us for this On Demand Webinar “Incident To Services: Compliant Use of Non-Physician Practitioners” tomorrow Friday, 14th Dec, 2012. This webinar can be accessed anytime of the day once registered.
Highlights of the session:

  • History of Non-Physician Practitioner (NPP) Services & State Scope of Practice/License.
  • Where do you find the most current and best resources for billing NPP services.
  • Which services can your NPP perform and options for billing them.
  • Levels of Supervision required at the various locations for a NPP to provide services.
  • Required Qualifications, Employment Relationships, Service Payment Methodology.
  • What can your NPP do to help with New Patient and Consultation visits.
  • Tips to consider if looking for an NPP to help your practice make the most informed decision.
  • Types of Nurse Practitioner Services That May Be Covered Under Medicare Reimbursement Rules.
  • Services Otherwise Excluded From Medicare’s Coverage.
  • Collaboration & Collaborative Agreements between a PA and one or more physicians (MD/DO).
  • Incident To Services under Medicare Benefit Policy Manual.
  • Integral Activities of the Physician’s/NPP’s Professional Service.
  • Plan of Care – What is it?
  • Split Shared Visits.
  • Inappropriate Documentation & Direct Billing.
  • FAQs on the most pressing and compelling challenges faced today.
  • And much more….

If interested, please click the following link to register and get your early bird discount :-
Please apply discount code “SAVE20” at checkout to get an additional $20 discount on registration.
Looking forward to having you onboard here.
Dave Johnson

This is a huge cottage industry, born out of the fear physicians have for suffering the fate of the doctor mentioned in Dr. Orient’s story.  I think more and more physicians will reject the money of the state purely out of fear.

G. Keith Smith, M.D.