WAEL A ABOUGHALI, M.D.

NPI 1447286158, individual, Baytown, TX, Family Medicine

Evidence tier

documented action, then payment

Listed on the Medicare revocation list since July 7, 2022.
Medicaid still paid claims in 5 later months, $10,371 in total.

score 94 of 100, rank 284, $10K at stake

Public list actions

Medicare revocation effective July 7, 2022, barred from re-enrolling until July 7, 2032

424.535(a)(9) failure to report and 424.535(a)(3) felonies, Practitioner - Family Practice, TX

OIG exclusion November 20, 2023 under section 1128a1

Physician (MD, DO), Family Practice, Pearland, TX

Paid after the action

Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.

list	identity check	action date	window closed	months paid after	first	last	paid after	12 months before
Medicare revocation list 424.535(a)(9) failure to report and 424.535(a)(3) felonies	Exact NPI, name verified	Jul 7, 2022	Jul 7, 2032	5	Aug 2022	Dec 2022	$10K	$12K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	WAEL A ABOUGHALI, M.D.
Type	Individual
Status	Active
NPI issued	June 24, 2006, last updated February 6, 2018
Practice location	1602 GARTH RD, Baytown, TX 77520-4002, 281-837-2700
Mailing address	6431 FANNIN ST, JJL 324, Houston, TX 77030
Specialties	Family Medicine (207Q00000X, primary, license M1444 TX)

Procedures billed

The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.

Medicaid, largest codes

code	what it is	paid	share	per patient-month	typical	rank among providers
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$14K	57%	$47	$60 (top 5% from $133)	33rd percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$10K	42%	$33	$44 (top 5% from $110)	33rd percentile
85025	Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	$180	1%	$7.20	$5.69 (top 5% from $25)	too few months to rank
83036	Hemoglobin a1c level	$130	1%	$5.21	$5.87 (top 5% from $14)	too few months to rank

In this area

219 providers in Harris County, TX carry an indicator in the public record, with $123.9M at stake between them. The most common is part of a provider network, on 162 of them, followed by more hours than a day holds on 43. 6 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	BLAKES BLESSING HEALTH CARE INC. Houston, TX, ranked 24	$2.1M	Listed on the TX Medicaid exclusion list since January 19, 2022. Medicaid still paid claims in 33 later months, $2,118,903 in total. and 1 more
1	BERNADETTE IGUH Houston, TX, ranked 182	$55K	Listed on the Medicare revocation list since October 4, 2017. Medicaid still paid claims in 42 later months, $55,127 in total.
1	CIBICARE FAMILY HEALTH CENTER INC Houston, TX, ranked 201	$44K	Listed on the Medicare revocation list since October 4, 2017. Medicaid still paid claims in 42 later months, $43,860 in total.
1	BILINGUAL PSYCHOLOGICAL ASSOCIATES PC Houston, TX, ranked 344	$3K	Listed on the TX Medicaid exclusion list since September 23, 2023. Medicaid still paid claims in 6 later months, $3,228 in total.
1	CULLEN FAMILY PRACTICE PLLC Houston, TX, ranked 346	$3K	Listed on the Medicare revocation list since October 4, 2017. Medicaid still paid claims in 9 later months, $3,140 in total.
1	HECTOR UBALDO Katy, TX, ranked 595	$0	Adjudicated (convicted) per a Department of Justice release dated November 8, 2024. No Medicaid payments in the last 12 observed months.
3	BELOVED HOME HEALTH SERVICES,INC Houston, TX, ranked 823	$4.6M	Part of provider network D1-00053, ranked 53 nationally. 100% of Medicaid dollars are on codes with a history of abuse.
3	APEX HOMEHEALTH SERVICES INC Houston, TX, ranked 827	$3.6M	Part of provider network D1-00036, ranked 36 nationally. 100% of Medicaid dollars are on codes with a history of abuse.

All 219 in TX

Recent enforcement in TX

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJCivil settlementAug 26, 2026

Dallas medical clinic to pay $7.5 million to resolve COVID-19 testing overbilling allegations

Aymancare billed the federal government's HRSA Uninsured Program for separate evaluation and management services in addition to COVID-19 specimen collection and testing at pop-up testing sites when no such separate services were performed.

DOJConvictedAug 12, 2026

Scammer pharmacist guilty in $20 million healthcare kickback scheme

Thomas paid over $2 million in kickbacks to the owner of a Houston clinic in exchange for referrals of DOL-OWCP insured patients prescribed high-reimbursement compounded medications, which his pharmacy then billed to DOL-OWCP, receiving more than $20 million in reimbursements.

DOJIndictedJun 24, 2026

U.S. Attorney Announces Major Health Care Fraud Cases in Western District of Texas

Charles is alleged to have received illegal kickbacks for referring patients to San Antonio area hospice companies, causing over $9 million in Medicare claims, while Dr. Duncan settled allegations of billing Medicare and TRICARE for an unapproved amniotic-based product and Trevor's Place settled allegations of submitting inflated TRICARE claims for services not provided.

DOJIndictedJun 23, 2026

Nine charged in SDTX as part of national health care fraud takedown

Nine defendants were indicted in the Southern District of Texas for operating pill mill clinics and a pharmacy that unlawfully distributed controlled substances, billing Medicaid $16 million for mental health services for minors that did not occur, and billing Medicare and TRICARE approximately $906 million for medically unnecessary amniotic wound allografts procured through kickbacks.

DOJChargedJun 23, 2026

Northern District of Texas Charges 13 Health Care Fraudsters for Loss Over $360 Million

Thirteen defendants in the Northern District of Texas were charged in seven cases involving more than $365 million in fraudulent billing to federally-funded programs and other insurers, including laboratory and genetic testing claims procured through kickbacks, transcranial magnetic stimulation treatments billed to TRICARE, medically unnecessary EEG testing, and hospice services never provided.

Referral packet

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