The criminal case stemmed from the surgeries, and coding, that Natale used a decade ago. Natale made "difficult, life-saving operations" and routinely worked extremely long days, but was consistently behind in dictating his operative reports, according to Orient.
Under federal billing requirements, physicians are required to use AMA-copyrighted codes. Natale allegedly incorrectly stated that he had used a bifurcation or Y-graft in repairing an abdominal aortic aneurysm instead of a straight tube graft actually used. Natale made errors in the reports, according to Orient.
For his part, Natale testified that he was instructed to use similar codes if he couldn't pick the right ones.
"These surgeries in question were done 10 years ago, and the doctor was an extremely busy surgeon from 5:30 a.m. until late at night, chronically behind on his operative reports," Orient says.
"When you dictate late, you are more likely to make mistakes, and when you look at the (Natale operative) report, there were mistakes, parts were incorrect. An essential part of the report is difficult to understand, or is easily misunderstood. Doctors aren't all that great at writing. And he just did a lousy job of explaining, but he saved patients' lives. He saved lives and he's in prison."