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A former doctor who at one point prescribed more oxycodone than most Massachusetts hospitals pleaded guilty in federal court Wednesday to fraud charges and is facing more than a decade in prison.

Patients allegedly waited in line for hours to see Fathalla Mashali, 62, who saw patients for only minutes at a time in an office at his pain clinics, rather than in an exam room.

Mashali caught the attention of authorities in 2013 because of the “strikingly high” rate of powerful painkillers such as oxycodone that he began prescribing to patients, according to court records.

In June 2012, Mashali was the eighth highest prescriber of oxycodone in Massachusetts, with 462 prescriptions. In May 2013, he became the second highest prescriber of oxycodone with 1,147 prescriptions, according to a 2013 affidavit by FBI special agent Andrea Kern.


Only Brigham & Women’s Hospital prescribed more oxycodone in May 2013 than Mashali, according to the affidavit.

“Based on my training and experience, Mashali’s more than doubling the number of oxycodone prescriptions written during a month over a period of 12 months is indicative of illegal drug distribution,” Kern wrote in the affidavit, adding that his subscription rate “suggests that he is engaging in illegal drug distribution.” Mashali also prescribed methadone and fentanyl, according to the affidavit.

Mashali, who relinquished his license in 2013, was not charged with any drug crimes, however.

“Really, the Mashali case is about the opioid crisis. He was a pain doctor and he was a powerful prescriber of narcotics,” said David Schumacher, a former prosecutor who is now a partner at Hooper, Lundy & Bookman and has followed the case. “But [prosecutors] had a whole lot of evidence of health care fraud. They meticulously built a paper heavy case with search warrants and other methods and were ultimately able to show a health care fraud scheme, and that’s what he ultimately pleaded guilty to.”


Mashali, who operated three pain management clinics in Massachusetts and one in Rhode Island under the banner New England Pain Associates, ran a multi-million-dollar scheme to cheat health insurance agencies, specifically Medicare. He ordered staff, including workers at an administrative office he ran in Egypt, to bill insurance agencies for services that were never rendered.

Assistant US Attorney Maxim Grinberg said Mashali used the revenue from the billing scheme to fund expansions to his Dover home, including a movie theater, a squash court, and a carriage house, and for real estate in Florida. Prosecutors say the conspiracy lasted from 2010 to 2013, when the investigation into Mashali began. He was indicted in 2014.

Legal analysts say the case illustrates the avenues prosecutors have taken to indict doctors who recklessly prescribe painkillers, without charging them with illegal drug dealing, which can be difficult to prove.

In 2015, prosecutors alleged that patients of a Needham doctor, Joseph Zolot, died from reckless prescriptions. But a jury acquitted him of drug dealing charges in his second trial, after the first trial ended with a hung jury.

“Those cases are hard; they’re hard to prove,” said Schumacher,who served eight years in the US attorney’s health care fraud unit. “They end up turning into a battle of experts,” disagreeing on whether a doctor acted appropriately or not, he said.

Mashali, who pleaded guilty to 44 counts of health care fraud, conspiracy, and money laundering, faces as much as 20 years in prison when he is sentenced in June.


The judge allowed Mashali to remain free until then so that he can receive treatment for depression and anxiety and other ailments at a hospital, rather than in prison. He must wear an electronic monitoring bracelet while he is free.

Milton J. Valencia can be reached at milton.valencia@globe.com. Follow him on Twitter @miltonvalencia.