Prosecutors and the Association of American Physicians and Surgeons agree that Natale's case should have a profound impact on physicians. They disagree sharply over what that message is.
"The need for deterrence is very strong in a case like this," said U.S. Attorney Amarjeet Singh Bhachu when Natale was sentenced. "A message needs to be sent out to doctors." The sentencing judge, Rebecca Pallmeyer, noted that "accurate coding is of extraordinary importance."
"The message to doctors is not to take Medicare money," Jane Orient, executive director of the AAPS, told me. "If you take it, you must comply perfectly with requirements, and this is impossible. They can't prosecute everyone of course; they could prosecute anyone."
The AAPS has joined in an appeal of Natale's conviction. It said that the criminalization of language used in medical reports would have a profound impact on the practice of medicine.
"The chilling effect caused by this conviction, if upheld, is undeniably profound for many physicians," the AAPS stated in papers filed with the court. "Physicians will now need to practice 'defensive documentation,' taking more time away from patient care in order to double-check and triple-check their operative notes—or say less in their notes—lest a few inevitable errors be used to incarcerate them and destroy their careers."
"This precedent criminalizes false statements in a private setting without any proof of billing fraud and a greater interference with the day to day practice of medicine is difficult to imagine," the AAPS added.