Pain physician charged in fraud scheme, ordered to pay $8.7M — 7 insights

Dover, Mass.-based pain management physician Fathallah Mashali, MD, was sentenced to eight years in prison and ordered to pay more than $8.7 million for defrauding Medicare, reports.

Here are seven insights.

1. Dr. Mashali was accused of falsely billing Medicare from approximately October 2010 through March 2013 for medical services he didn't provide. In March 2017, he pleaded guilty to 44 counts of healthcare fraud, conspiracy to commit mail fraud and money laundering.

2. Dr. Mashali documented that he conducted extensive physical exams, claiming each visit lasted at least 25 minutes, but often saw his patients for less than five minutes.

3. Dr. Mashali didn't perform any physical examinations and or adequately address patients' medical status or history during the short encounters, yet he overprescribed powerful narcotics that resulted in fatal overdoses for some patients.

"At one point, Dr. Mashali was one of the highest-volume prescribers of oxycodone in Massachusetts, second only to a leading Boston hospital," said U.S. Attorney Andrew Lelling.

4. Dr. Mashali billed Medicare and private insurers for drug test results from invalid urine samples that had been stored up to three months, not refrigerated, in a sunlit space. He instructed lab technicians to move the unrefrigerated urine out of sight during inspections and test samples in ways that violated Medicare billing rules.

When the federal government began investigating Dr. Mashali's billing practices and requested 40 patient medical files for an audit, Dr. Mashali caused his staff to engage in falsification of patient records, including faking and backdating patients' urine drug test results.

5. Dr. Mashali overbooked appointments and sometimes arrived to work up to four hours after his first scheduled appointment, causing overcrowding that would prevent meaningful assessment of each patient.

6. Dr. Mashali spent the money obtained from illegal Medicare billing on his residence in Dover, Mass., which was adorned with a squash court and movie theater, as well as a Florida condominium.

7. "This sentence ensures that Dr. Mashali will never again treat — or mistreat — patients in order to line his own pockets at the expense of patient care," Mr. Lelling said.

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