Physician Convicted of False Billing Scheme

Whether or not a physician violates the False Claims Act when knowingly submitting claims for reimbursement for fictitious services and fabricated lab results?

A physician, Moustafa Moataz Aboshady, was convicted recently by a federal jury on one count of conspiracy to make a false statement and falsify patient medical records to obtain payments from Medicare and commercial insurers for medical services that were not performed.

Aboshady was a medical resident in Massachusetts and Rhode Island, employed at New England Wellness & Pain Management, P.C., also known as New England Pain Associates (NEPA), P.C., Greystone Pain Management, Inc., and New England Pain Institute, P.C. NEPA had locations in Massachusetts and Rhode Island, and was operated by Fathallah Mashali, a pain management physician who earlier 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.

Falsified patient encounter notes included detailed descriptions of extensive physical examinations and treatment plans to create the appearance of lengthy and involved patient encounters, when 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 with the Cairo office was responsible 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.  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.

Compliance Perspective – False Billing:

The Compliance and Ethics Officer will review the facility’s policies and procedures with the Administrator to verify that policies are in place regarding the facility’s interactions with other healthcare providers, i.e., hospitals, physicians, pharmacy or device representatives, venders, etc. To ensure that no excluded or sanctioned entity or individual is providing services to the facility and to the residents,  Administrative Staff should be educated and trained in the protocols to use to perform background checks and screen for excluded individuals or sanctioned entities by the Office of the Inspector General. An audit should be conducted periodically to ensure that healthcare providers being used by the facility have been screened for exclusions and/or sanctions by the OIG. To enhance communications between the facility and the residents, educational information could be shared through the Residents’ and Family Councils. This will help raise awareness about potential fraud and encourage them to audit their Medicare statements or statements from other reimbursement programs for any discrepancies regarding services or devices they may not have received or needed.