In an attempt to defraud Medicare, Dr. Fathallah Mashali, 62, was sentenced to 8 years in prison, and ordered to pay restitution of $8,725,120 to his victims. This week, Mashali plead guilty to 27 counts of healthcare fraud and 16 counts of money laundering.
Mashali was licensed to practice medicine and operated various pain management and wellness centers in the greater Massachusetts and Rhode Island areas. While prescribing large amounts of oxycodone to his Massachusetts patients, he asked his employees overseas to enter false information into patient medical records, ultimately attempting to defraud Medicare.
For months, Mashali falsely billed Medicare for medical services not provided. Mashali falsely stated to Medicare and other private insurance companies that his consultations with patients were 25 minutes per appointment or longer. In reality, an average appointment with Mashali lasted less than five minutes.
Negligence with Patients and Test Results
Mashali never performed any physical examinations nor inquired about the patient’s medical history. Mashali also falsely documented that he did conduct these physical exams, thereby obtaining unnecessary reimbursement from Medicare.
He is also accused of being negligent with test results, causing unsanitary conditions in his offices. He performed tests that were contrary to Medicare billing rules, and also used invalidated chemical analyzers that produced inaccurate results.
Medicare inquired about Mashali’s potential unlawful billing practices initiating an audit of 40 patient medical files. This caused Mashali to instigate a massive cover up, asking his staff to alter patient records. This included faking and backdating the results of urine tests.
Overprescribing Narcotics and Opioids
United States Attorney Andrew E. Lelling has accused Mashali of running a “pill mill”, and overprescribing narcotics at a time when this is a controversial issue among patients and doctors. “Through his fraudulent schemes, Dr. Mashali exposed his patients to unnecessary risks, over-prescribed medications including powerful opiates, and recklessly failed to provide the appropriate level of treatment expected from our health care professionals,” said Special Agent Harold Shaw, FBI, Boston Field Division. The FBI began exploring this case in order to protect taxpayer funded programs.
“Today’s sentence underscores our ongoing commitment to protecting the American people from all forms of healthcare fraud, safeguarding taxpayer resources and ensuring the integrity of essential healthcare programs,” said Special Agent in Charge Phillip M. Coyne.
Mashali ultimately jeopardized his patients’ lives. He pleaded guilty to providing substandard care contributing to the current opioid epidemic. The IRS will continue to assist the FBI and the IFB in further investigating these types of healthcare schemes, hoping to prevent further negligence to already vulnerable patients.
Overall Mashali is being accused of not only exploiting his patients, and insurance companies, but pocketing enough money to enjoy a lavish lifestyle. With the money Mashali received from Medicare he was able to build a residence in Dover with a carriage house, squash court, and a movie theater, and a vacation condominium in Florida.
To learn more about this case or report suspected healthcare fraud, contact Newman & Shapiro today!