At Dr. Fathalla Mashali’s pain management clinics, the waiting rooms were often so packed with patients that people sat on the floor, leaned against walls and spilled into the hallways.
That’s because, federal prosecutors say, Mashali was prescribing oxycodone and other powerful opioid painkillers at alarming rates to people making risky use of drugs. At one point, they say, Mashali wrote out more oxycodone prescriptions in one month — over 1,100 — than some of the largest hospitals in Massachusetts.
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Prosecutors nationwide have cracked down on so-called pill mills like the pain management clinics run by Mashali, places where prescriptions are often handed out without physical exams or tests to determine whether a legitimate condition requires pain medication.
Prosecutors in Boston say Mashali would often see more than 100 patients in one day. A medical assistant who worked at one of Mashali’s offices told investigators that only about 5 percent of his patients had legitimate medical conditions. In a letter to the FBI and the Drug Enforcement Administration, four former employees alleged Mashali was prescribing high-dose narcotics to patients who were “clearly drug-seekers or whose ailments did not warrant that type of treatment,” an FBI agent wrote in an affidavit.
Mashali was expected to plead guilty earlier this month to 44 counts of healthcare fraud, conspiracy to commit mail fraud and money laundering. But after he declined to acknowledge personal responsibility during a change-of-plea hearing on March 2, the judge refused to accept his guilty plea. Another hearing is scheduled for Wednesday. Mashali’s attorney declined to comment before the hearing. Mashali has an unpublished telephone number and could not be reached for comment.
Mashali, 62, was born in Egypt and received a medical degree from Cairo University. He moved to the United States more than 30 years ago, became a permanent resident, got married, had four children and served as a captain in the U.S. Army Reserve.
In the early 2000s, Mashali began operating a pain management clinic, eventually opening three offices in Massachusetts and one in Rhode Island. As his practice grew, so did his personal spending. In 2008, Mashali filed for bankruptcy, listing $12 million in debts.
Prosecutors say he used the proceeds from his thriving practice to pay for a lavish lifestyle. In 2011, after emerging from bankruptcy, he and his wife bought a $2.2 million home in Dover, one of the wealthiest towns in Massachusetts, and made approximately $2 million in improvements, adding a carriage house with a squash court and 20-seat theater, a pool with a patio and kitchen, a heated driveway and a four-car garage.
“The evidence will show that Mashali’s lust for exuberant wealth and luxury severely compromised the care and safety of his vulnerable patients,” prosecutors wrote in a trial brief last month.
Mashali’s practice began to fall apart in 2012, when his former employees alleged he was prescribing high doses of drugs to patients with addictions and fraudulently billing for physical exams and urine tests he never did.
In 2013, the Rhode Island Board of Medicine revoked his medical license, finding that he had provided “substandard care” to six of seven patients who died. After that, Mashali voluntarily surrendered his Massachusetts license.
He was arrested on Feb. 7, 2014, while attempting to board a plane to Egypt on a one-way ticket.
In court filings, Mashali’s lawyers have said he has severe bipolar disorder and neurosarcoidosis, a central nervous system disease that can be characterized by confusion or dementia.
During the earlier hearing, Mashali told Judge Rya Zobel that he was depressed, overworked and sometimes nodded off while seeing up to 70 patients a day. He said he did not know that his practice was billing Medicare and private insurance companies for services he did not perform.
“I was not aware, but I will take the plea. I am guilty. The practice is guilty. So, I am guilty,” he said.
Zobel told him she could not accept his guilty plea unless he admitted that he knew about the filing of false insurance claims.
Prosecutors said federal sentencing guidelines call for a sentence of between 12½ and 15½ years.
The Associated Press contributed to this article