Pain Management Physician Charged with Overbilling Medicare

BOSTON—A physician specializing in pain management was charged today for overbilling the Medicare program.

Fathalla Mashali, 59, of Dover, was indicted on nine counts of heath care fraud.

Mashali was a licensed physician in Massachusetts and Rhode Island who operated 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. (NEPA). NEPA, a pain management clinic with locations in Massachusetts and Rhode Island, served many patients who were Medicare beneficiaries.

The indictment alleges that Mashali trained NEPA employees, including physician assistants and registered nurses, to overbill the Medicare program. Mashali overbooked patient appointments, sometimes with as many as four patients per slot, and arrived to work up to four hours late, causing significant overcrowding at NEPA’s waiting rooms. The patient appointments often lasted less than 10 minutes and sometimes as few as two to three minutes. Mashali often saw patients without performing physical examinations. The indictment also alleges that with the exception of patients requiring injections, Mashali conducted patient visits in a small office with a desk, resembling a business office, rather than in an examination room containing medical equipment. Nevertheless, Mashali submitted fraudulent claims to the Medicare program seeking reimbursement for patient services far exceeding in scope and duration the actual services he provided to patients.

If convicted, Mashali faces a maximum sentence under the statute on each count of health care fraud of 10 years in prison, three years of supervised release and a fine in the amount of $250,000 or twice the pecuniary gain to Mashali or loss to the Medicare program, and restitution.

United States Attorney Carmen M. Ortiz; John J. Arvanitis, Special Agent in Charge of the Drug Enforcement Administration, Boston Field Division; Vincent B. Lisi, 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 William P. Offord, Special Agent in Charge of the Internal Revenue Service’s Criminal Investigations in Boston, made the announcement today. The case is being prosecuted by Kimberly P. West and Lisa Asiaf-Schlatz of Ortiz’s Health Care Fraud Unit and Katherine Ferguson of Ortiz’s Drug Task Force Unit.

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