Fraud is Painful

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Expensive medicine. Medical insurance. Drug addiction. Money and pills. Drugs.

Pain clinics typically provide solutions for unmanageable pain caused by conditions such as arthritis, back pain, cancer, migraines and neck pain just to name a few. (When an over-the-counter remedy doesn’t work, these are the people to contact.) Two pain management doctors in the New England area, who had offices in Massachusetts, Rhode Island and Cairo, Egypt were recently convicted of Medicare fraud for operating a dangerous pain management practice that doled out narcotics to addicted patients.

A doctor from Lake Forest, California, who was a medical resident at the now closed New England pain management clinics, helped his co-defendant operate one of the most dangerous pain management practices in Massachusetts. The medical resident used his training to create patient records that could be used to fool Medicare and other private insurers into paying his co-conspirator for services that were not provided. He faked detailed descriptions of extensive physical exams and treatment plans as well as the length of his face-to-face interactions with patients, surpassing 20 to 40 minutes for each appointment. (Most of us are lucky to get five minutes with a doctor.)

The intern directed the Cairo, Egypt office on how to create fake patient encounter notes and bogus electronic signatures and timestamps to make the notes appear real. He also created fake urine drug test results complete with false test dates, so it looked like drug tests were performed within several days of the specimen collection. (The specimens were actually collected and stored unrefrigerated for up to three months in large bags.) The attempts at falsification supported the urine drug test billing codes provided to Medicare and other private insurers.

The 36-year-old intern from Lake Forest, California, who was found guilty of Medicare fraud, was sentenced to prison for more than six years to be followed by three years of supervised release. He was also ordered to pay restitution of $1,852,459. His co-conspirator received a sentence of eight years in prison after pleading guilty to 27 counts of healthcare fraud, one count of conspiracy to commit mail fraud and 16 counts of money laundering.

It’s important to note that the National Institute on Drug Abuse reports that Massachusetts is among the top ten states with the highest rate of drug overdose deaths from opioids. In 2017, 1,913 drug overdose deaths occurred in the state. That’s a rate of 28.2 deaths per 100,000 people. (That’s a sobering statistic because that’s twice as much as the national rate.) A special thanks goes to the FBI Boston Division for shutting down this painful and illegal fraud operation. (Perhaps it saved a few lives in the process.)

Today’s “Fraud of the Day” is based on an article, Physician sentenced to 6 years in prison for operating ‘dangerous pain clinic,’ bilking insurance companies,” posted on masslive.com on February 6, 2019.

BOSTON – A physician convicted of fraudulently billing Medicare and private insurance companies while operating a “dangerous pain management practice” and dispensing large quantities of narcotics to addicted patients was sentenced to more than 6 years in prison and ordered to pay $1.8 million in restitution.

Moustafa Moataz Ibrahim Aboshady, 36, of Lake Forest, Calif., was found guilty of one count of conspiracy to make false statements in connection with health care benefit programs and two counts of making false statements in connection with health care benefit programs by a federal jury in September.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.