Notice to Potential Victims Regarding Former Employee of Massachusetts and Rhode Island Pain Clinic Charged in Fraudulent Billing Scheme

BOSTON – Moustafa Moataz Aboshady, 35, an Egyptian national residing in Lake Forest, Calif., was indicted in September 2016, in U.S. District Court in Boston, on one count of conspiracy and two counts of making false statements in connection with health care benefit programs. A trial date is not scheduled at this time.

Insurance companies and patients who believe they may be potential victims of this fraudulent billing case, will find additional information about this case on the U.S. Attorney’s Office website https://www.justice.gov/usao-ma and the U.S. Department of Justice website https://www.justice.gov/largecases. Potential victims who can document direct and proximate harm, including financial loss suffered as a result of the alleged conduct in the indictment, may complete the potential victim identification form and return it to the United States Attorney’s Office for determination of their crime victims’ rights status.

As alleged in the indictment, Aboshady was a medical resident in Massachusetts and Rhode Island, employed at New England Wellness & Pain Management, P.C., which was also known as New England Pain Associates, P.C., Greystone Pain Management, Inc., and New England Pain Institute, P.C., or NEPA.

NEPA had locations in Massachusetts and Rhode Island. The indictment alleges that Aboshady was part of a conspiracy involving other members of NEPA, including its owner and members of a satellite office in Cairo, Egypt, in connection with a scheme to falsify patient medical records in order to obtain payments from the Medicare program and commercial health insurance companies. The alleged conduct included submitting claims for payment to Medicare and commercial health insurance companies for services not rendered.

As part of the alleged scheme, Aboshady falsified, and instructed others to falsify, patient encounter notes. Such false information included, but was not limited to, detailed descriptions of extensive physical examinations and treatment plans and durations of face-to-face interactions with patients to create the appearance of lengthy and involved patient appointments, when in fact these services did not take place.

Aboshady is allegedly responsible, in conjunction with the NEPA owner and the Cairo office, for fabricating the dates of urine drug test results so that the tests appeared to have been performed within days of specimen collection rather than weeks or months thereafter. This information was necessary to support billing codes submitted to Medicare and private insurers. The indictment alleges that NEPA tested patients’ urine weeks and sometimes three months after the specimens had been collected and stored the specimens in unrefrigerated large plastic bags and containers.

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