Telemedicine Nurse Practitioner Pleads Guilty to $7.8 Million Durable Medical Equipment Fraud Scheme
Psychiatrist Convicted of Billing Medicare and Private Insurance Companies for Services Never Rendered
BOSTON – A physician at the now-defunct New England Pain Management Associates Inc. was sentenced today in federal court in Boston for conspiring to falsify patient medical records in order to obtain payments from Medicare and commercial insurers for medical services that were not performed.
Moustafa Moataz Ibrahim Aboshady, 36, of Lake Forest, Calif., was sentenced by U.S. District Court Judge Nathaniel M. Gorton to 75 months in prison, three years of supervised release and ordered to pay restitution in the amount of $1,852,459. In September 2018, a federal jury convicted Aboshady of 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. In March 2018, co-conspirator Dr. Fathalla Mashali was sentenced to eight years in prison after pleading guilty to 27 counts of health care fraud, one count of conspiracy to commit mail fraud and 16 counts of money laundering.
“Mr. Aboshady helped Dr. Mashali operate one of the most dangerous pain management practices in Massachusetts,” said United States Attorney Andrew E. Lelling. “Dr. Mashali routinely dispensed large quantities of powerful narcotics to addicted patients. Mr. Aboshady assisted Dr. Mashali’s illegal behavior by using his training as a doctor to fabricate patient records, with the goal of duping Medicare and other insurers into paying Dr. Mashali for his fraudulent conduct. Moreover, Aboshady later lied about Mashali’s medical practices to regulatory authorities.”
“Dr. Aboshady engaged in unlawful, unethical, and unprofessional conduct. He used the Medicare system as his own personal ATM, cheating taxpayers and private insurance companies out of thousands of dollars by billing them for medical services that were never performed. The FBI is committed to protecting government and private health care programs and stopping those who steal from them,” said Joseph R. Bonavolonta, Special Agent in Charge of the FBI Boston Division.
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.
Aboshady conspired with Mashali, other members of NEPA, and members of a satellite office in Cairo, Egypt, 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 on how to fake patient encounter notes, how 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 fabricating 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. In addition, in response to a subpoena from the State of Rhode Island concerning some of Mashali’s patients, Aboshady helped Mashali falsify patient medical records.
“Healthcare fraud is corrosive, wasting taxpayer dollars, driving up healthcare costs, and undermining the Medicare program,” said Phillip M. Coyne, Special Agent in Charge for the U.S. Department of Health & Human Services, Office of Inspector General. “Aboshady’s falsification and fabrication of medical records to further his healthcare fraud scheme compromised the integrity of our public healthcare system, and we will continue to aggressively investigate such reckless conduct.”
“I hope this sentence sends a message to other medical providers that medical billing fraud is not tolerated in Massachusetts and when caught, you will pay a price,” said Anthony M DiPaolo, Chief of Investigations of the Insurance Fraud Bureau. “This matter also illustrates the commitment of all agencies to combat medical billing fraud which affects all citizens. The Insurance Fraud Bureau of Massachusetts places a high priority on fighting this type of insurance fraud. The collaboration in this matter is unprecedented.”
U.S. Attorney Lelling; Boston FBI SAC Bonavolonta, HHS-OIG SAC Coyne, and Massachusetts IFB Chief of Investigations DiPaolo, made the announcement today. Assistance was also provided by the Internal Revenue Service’s Criminal Investigation in Boston. Assistant U.S. Attorneys Abraham R. George, Senior Litigation Counsel of Lelling’s Civil Division, and David G. Lazarus, Chief of Lelling’s Asset Recovery Unit, prosecuted the case.