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.
Mashali pleaded guilty Wednesday to 44 counts of health care fraud, conspiracy to commit mail fraud and money laundering, offering a brief apology during his change-of-plea hearing in U.S. District Court.
"I'm very sorry. I hurt my family. I hurt my patients," Mashali said.
Sentencing is scheduled for June 21. Prosecutors said in a court filing that federal sentencing guidelines call for 12½ to 15½ years in prison.
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 said 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.
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.
"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 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 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 Wednesday's hearing, Mashali said he is taking more than 20 medications for those illnesses, as well as anxiety and depression.
"As the sentencing hearing will show, he is a deeply troubled individual whose underlying psychopathology in large part contributed to the offense conduct," Mashali's attorney, Jeffrey Denner, said after the hearing.
Assistant U.S. Attorney Maxim Grinberg asked for Mashali to be taken into custody while awaiting sentencing.
But Judge Rya Zobel said he could remain free so he can continue to receive daily treatment at a psychiatric hospital. She ordered him to wear an electronic monitoring bracelet.