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Judge backs Medicare’s revocation of billing rights

Leading specialist has been seeing patients for free

By Robert Weisman
Globe Staff / May 19, 2010

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A federal judge has ruled Medicare acted properly in 2007 when it revoked the billing rights of a Boston dermatologist who has helped hundreds of patients with rare skin diseases, but also pleaded guilty to backdating letters and falsifying medical tests in what he said was an effort to get insurance coverage for patients.

The decision by Judge Douglas P. Woodlock at US District Court in Boston means the federal government will not reinstate Dr. A. Razzaque Ahmed’s billing privileges. Ahmed, who runs a private practice on Mission Hill, is a leading specialist on pemphigus and pemphigoid, blistering disorders that cause painful scalp sores, crumbling mouth tissue, and eyelids to fuse to eyeballs.

Ahmed said he has been seeing about 130 older patients free of charge since Medicare barred him from submitting bills, referring many of them to other doctors who administer the drug treatments he designed. Yesterday he said he planned to consult with his lawyers about how to proceed in light of Woodlock’s decision. He said he hopes to reapply for reimbursement rights to a regional Medicare contractor. “My feeling is there is a large patient base that needs to be served and that patient base can benefit from my services,’’ Ahmed said. “I think all the time about what is in the best interests of the patients.’’

Ahmed, though an admitted felon, has been hailed as a hero by scores of patients who say his experimental treatments involving an expensive drug called intravenous immunoglobu lin, or IVIG, caused their symptoms to ebb, improving — and in some cases — saving their lives.

Prosecutors said Ahmed submitted medical records for about 94 pemphigoid patients, many of them covered by Medicare, falsely suggesting they also suffered from pemphigus. At the time, the regional Medicare office only reimbursed for pemphigus treatments. By submitting paperwork for dual diagnoses he was still able to receive Medicare payments for his services. Ahmed said he only wanted to make sure his patients were covered by insurance, though he and a nursing contractor profited from a portion of the Medicare payments.

Medicare revoked his billing privileges in November 2007 after he entered into an agreement with prosecutors to plead guilty to one count of obstructing a criminal investigation of health care offenses. In return, the government dropped 14 other charges against Ahmed.

Ahmed was sentenced to two years of probation — including six months of home confinement — and ordered to complete 400 hours of free medical service as a condition of his probation. He also made a forfeiture payment of $2.9 million to the government, and paid a separate $20,000 fine.

Judge Woodlock, in his decision, rejected Ahmed’s argument that his offense didn’t constitute a financial crime that would bar him from Medicare billing. “The obstruction charge for which Ahmed was convicted is a criminal offense that bears the DNA of insurance fraud in the health care setting,’’ the judge wrote in the ruling.

Representatives of the US attorney’s office in Massachusetts, which made the case for the Medicare appeals board and its parent agency, the Department of Health and Human Services, didn’t respond to a request for comment yesterday.

Howard J. Young, a lawyer at the Washington, D.C., firm of Morgan, Lewis & Bockius who represents Ahmed, said he and his client are looking at options. “We are still working through all the issues,’’ Young said. “What he is most interested in doing is to be able to treat his Medicare patients, and to get paid for treating his Medicare patients.’’

In March, another arm of the health and human services department, the Office of Inspector General, determined it would not exclude Ahmed from Medicare reimbursements on a long-term basis. That decision is not binding on the Medicare regional office in Hingham where Ahmed submits insurance claims. The regional office is run by a Medicare contractor, National Heritage Insurance Co.

Robert Weisman can be reached at weisman@globe.com.