Pain Management Physician Indicted For Overbilling The Medicare Program

BOSTON – A physician specializing in pain management was charged in a superseding indictment today for overbilling the Medicare Program.

Fathalla Mashali, 59, of Dover, was charged with 23 counts of heath care fraud in connection with billing the Medicare Program for services that he did not provide to his Medicare patients between October 2010 and March 2013. Mashali will be arraigned on Oct. 29, 2014 in U.S. District Court in Boston.

According to the original indictment, returned in March 2014, Mashali was a licensed physician in Massachusetts and Rhode Island, and operated New England Wellness & Pain Management, P.C., a/k/a New England Pain Associates, P.C., of Massachusetts and Rhode Island, a/k/a Greystone Pain Management, Inc., a/k/a New England Pain Institute, P.C. (NEPA). Many of the patients at NEPA were Medicare beneficiaries.

It is alleged that Mashali trained NEPA employees, including physician assistants and registered nurses, to overbill the Medicare Program. According to the indictment, Mashali overbooked patient appointments, sometimes with as many as four patients per appointment slot, and arrived to work up to four hours late. The patient appointments often lasted less than 10 minutes and sometimes as few as two minutes during which he often failed to perform physical examinations. With the exception of patients requiring injections, Mashali conducted patient visits in a small office with a desk, resembling a business office, rather than in an examination room containing medical equipment. Nevertheless, Mashali allegedly submitted fraudulent claims to Medicare seeking reimbursement for patient services far exceeding in scope and duration of the actual services he provided to his Medicare patients.

The superseding indictment adds the additional allegations that between November 2011 and October 2012, while the laboratory was not in compliance with federal regulations, Mashali billed Medicare for urine drug tests he did not perform. Mashali collected urine specimens from his patients and tested them for drugs, presumably to determine whether the patients were using abusive drugs and whether they consumed their prescription medication. According to the indictment, Mashali contemporaneously tested each urine specimen at his laboratory in Holbrook, Mass. on two chemical analyzers, and billed Medicare for those tests. In addition, he billed Medicare for a third test, known as a confirmatory test, which he did not perform. Although the administration of a confirmatory test would have depended on the outcome of the initial urine test, it is alleged that Mashali billed for the confirmatory tests before he conducted any urine tests whatsoever.

Furthermore, Mashali allegedly tested the urine weeks and sometimes three months after it had been collected from his patients. The urine was kept unrefrigerated, and, due to the age of urine and storage conditions, it leaked from collection cups while the smell permeated the laboratory. Prior to an inspection by a federal health inspector in February 2012, Mashali ordered his staff to move the unrefrigerated urine specimens out of the laboratory, but then returned the specimens following the inspection.

The maximum sentence under the statute on each count of the indictment is 10 years in prison, three years of supervised release, a fine of $250,000 or twice the pecuniary gain to Mashali or loss to the Medicare program, and restitution. Actual sentences for federal crimes are typically less than the maximum penalties. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors.

United States Attorney Carmen M. Ortiz; Michael J. Ferguson, Acting Special Agent in Charge of the Drug Enforcement Administration, Boston Field Division; Vincent B. Lisi, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; Phillip Coyne, Special Agent in Charge of the U.S. Health and Human Services, Office of the Inspector General; Office of Investigations; Anthony DiPaolo, Chief of Investigations of the Massachusetts Insurance Fraud Bureau; and William P. Offord, Special Agent in Charge of the Internal Revenue Service’s Criminal Investigation in Boston made the announcement today. The case is being prosecuted by Maxim Grinberg and Kimberly P. West of Ortiz’s Health Care Fraud Unit and Katherine Ferguson of Ortiz’s Drug Task Force Unit.

The details contained in the indictment are allegations. The defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.