This link is a report by the Association of American Physicians and Surgeons (AAPS) on the imprisonment of Dr. John Natale.  A vascular surgeon, Dr. Natale was convicted of making a mistake on the wording of his dictation report on two operations on Medicare beneficiaries, mind you, not errors that would have resulted in more payment from Medicare.  Acquitted of fraud, guilty of a mis-statement, he is nevertheless off to jail for 10 months.  You should read this if you have 5 minutes.  Unlike most of the D.C. sleaze, he was not granted the opportunity to “revise and extend his remarks.”

This link is the amicus brief filed on behalf of Dr. Natale by the brilliant Andrew Schlafly, counsel for the Association of American Physicians and Surgeons.  You should read this if you have another 10-15 minutes, a sample of this man’s towering intellect, at once, deeply profound but readable.    

I think it is important to note that not only was the American Medical Association nowhere to be seen in the defense of Dr. Natale, they are the authors of the uninterpretable codes and rules that ensnared Dr. Natale, the very rules the federal government paid them to pen.  Dr. Natale’s story should cause any physician belonging to the AMA to re-evaluate that decision.  Likewise, any physician that is not a member of the AAPS should give this decision some thought, as well.

I want to emphasize that Dr. Natale was not convicted and imprisoned for Medicare fraud, the billing practices that result in “improper” overpayment from the government.  He was convicted and imprisoned for things he said in two dictation reports, the “falseness” of which were “verified” by an “expert” witness for the government, one who was not only not a vascular surgeon like Dr. Natale, but one who was indeed, a former competitor of Dr. Natale’s.  

If you are a physician reading this, you find this chilling, no doubt, unless you have never made a mistake on a dictation report.  If you are a Medicare beneficiary, while you may not completely grasp the nuances of what this means within our profession, your access to care using your Medicare card is probably the primary casualty of this ruling against Dr. Natale.  Paid poorly by the government with pay cuts undoubtedly on the horizon, the risk of imprisonment by faulty dictation now looms.  Uncle Sam might as well have burned all the wheelchair ramps to doctor’s offices.

For those of you who are saying, “He messed up, that’s the law, he broke the law, he should go to jail,” you should take another look at this course (one of many) the sole purpose of which is to help physicians navigate the mine field of Medicare rules and regs.  Keep in mind that avoiding mis-statement on a dictated report is not part of the course.  Dr. Natale, having avoided the government’s labyrinthine web of traps (a notable feat in itself) was nailed for a non-crime.  

It is obvious that the government wasn’t interested in the prevention of fraud, as Dr. Natale was imprisoned in spite of his acquittal on these counts.  The most extreme Medicare fraud is of course legal, the result of intense lobbying by the medical cartel, occurring on a regular and daily basis and with the sanction of government.  A legislative staffer in D.C. told me that Medicare pays local “not for profit” hospitals in Oklahoma City, twice the amounts listed on our website.  The local corporate teaching hospital is paid twice as much for a joint replacement as that paid to the physician-owned facility doing joint replacements here in town.  Medicaid pays the local “not for profit” hospitals more (much more) than the prices we have listed on our website.  How did this happen?  This is government-sanctioned (purchased) fraud, the result of shameless influence peddling, and in spite of its bankrupting results on all of us, no one in the government is addressing this.  Rather, they choose to outlaw cheaper physician-owned hospitals as part of Obamacare and imprison an innocent man.  Go figure.

I have not dealt with Medicare or Medicaid since 1994.  The Surgery Center of Oklahoma has never dealt with Medicare or Medicaid.  More and more physicians will be moved to shrug off the yoke of government payment as a result of this ruling against Dr. Natale, for fear of suffering the same fate.  As tragic as this must be for Dr. Natale and his family, his plight may serve to bring a heightened awareness to the disaster of government involvement in medicine among the targeted physicians and the increasing number of abandoned beneficiaries of these government payment programs.  Natale’s case also makes it more clear than ever that possession of a government “health card” represents no “right to care,” but rather an obstacle.

G. Keith Smith, M.D.