Physician Convicted of False Billing Scheme
BOSTON – A physician and former employee of New England Pain Management Associates, Inc. was convicted today by a federal jury of conspiring to falsify patient medical records between May 2012 and May 2013 in an effort to obtain payments from Medicare and commercial insurers for medical services that were not performed.
Moustafa Moataz Aboshady, 36, of Lake Forest, Calif., was convicted on one count of conspiracy to make false statements in connection with health care benefit programs and two counts of making false statements in connection with health care benefit programs.
During the time of the conspiracy, 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, and was operated by Fathallah Mashali, a pain management physician. Mashali pleaded guilty to 27 counts of health care fraud, one count of conspiracy to commit mail fraud, and 16 counts of money laundering and was sentenced in March 2018 to eight years in prison and three years of supervised release.
Aboshady was part of a conspiracy involving Mashali, other members of NEPA, and members of a satellite office in Cairo, Egypt, whose purpose was to falsify medical records and urine drug test results to support claims for payment to Medicare and insurers for services that Mashali did not render.
Part of the conspiracy involved falsification of 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 exceeding 20 to 40 minutes per appointment, to create the appearance of lengthy and involved patient encounters, when in fact these services did not take place. Aboshady instructed the Cairo office to create false electronic signatures on the encounter notes and how to make the timestamps for those signatures look realistic.
Aboshady was also responsible, in conjunction with the office in Cairo, for the fabrication of urine drug test results with false test dates, 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 urine drug test billing codes submitted to Medicare and insurance companies. In fact, NEPA tested patients’ urine weeks and sometimes three months after the specimens had been collected and stored unrefrigerated in large plastic bags and containers.
The charges provide for a sentence of no greater than five years in prison, three years of supervised release, a fine of $250,000 and restitution. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors.
United States Attorney Andrew E. Lelling; Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; Phillip Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of the Inspector General, Office of Investigations; Anthony DiPaolo, Chief of Investigations of the Massachusetts Insurance Fraud Bureau; and Kristina O’Connell, Special Agent in Charge of the Internal Revenue Service’s Criminal Investigation in Boston made the announcement today. Assistant U.S. Attorneys Abraham R. George, Senior Litigation Counsel of Lelling’s Civil Division, and David G. Lazarus, Chief of Lelling’s Asset Forfeiture Unit, prosecuted the case.