Retraction Watch

Tracking retractions as a window into the scientific process

Alleged Medicare cheat loses paper for data mix-up

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A Boston doctor indicted on charges of Medicare fraud in 2007 has had a paper relating to the case retracted this month.

Abdul Razzaque Ahmed was considered something of a miracle worker by his patients, treating two rare and disfiguring skin conditions called pemphigoid and pemphigus vulgaris. He used more powerful medicines than the typical course of treatment, including a drug normally used to treat cancer.

The initial indictment stated that Ahmed mixed blood samples to falsely show a “dual diagnosis” of both diseases, and prove to Medicare that they required the more rigorous (and expensive) treatment. It also alleged that he profited massively from the government pay-outs. He was convicted of obstruction in 2007; the other charges were dropped when he agreed to forfeit assets worth $2.9 million.

Now, a 2001 paper by Ahmed, which claimed fifteen patients had a dual diagnosis, has been retracted because the samples were all mixed. Here is the retraction notice from Clinical Immunology:

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).

This article has been retracted at the request of the senior author Dr. A. Razzaque Ahmed. The author had claimed the coexistence of pemphigoid and pemphigus vulgaris. The serum used contained DNA from different individuals. Consequently, the results are not reliable.

The paper has been cited 13 times, according to Thomson Scientific’s Web of Knowledge.

Ahmed’s right to bill Medicare was revoked in 2007, and he lost an appeal of the decision in 2008. According to the appeal:

The regulatory authority cited for the revocation was 42 C.F.R. § 424.535(a)(3)(i)(B) based upon Petitioner’s felony conviction of “a single count of obstruction.” CMS Exhibit (CMS Ex.) 2; Petitioner’s Exhibit (P. Ex.) 9. Petitioner requested reconsideration by a contractor hearing officer who issued a decision on March 12, 2008. The hearing officer sustained the revocation pursuant to 42 C.F.R. § 424.535(a)(3)(i)(B) based upon Petitioner’s felony conviction.

Also in 2001, Ahmed published a paper in Dermatology that claimed to be a case study of 30 patients with a dual diagnosis. That paper has not been retracted. Here’s the abstract:

Abstract

BACKGROUND:

Pemphigus and pemphigoid are two distinct groups of autoimmune blistering diseases. There are many reports of the simultaneous presence of clinical and serological features of both diseases in the same patient.

OBJECTIVE:

This study is a retrospective review of the present literature on reports of patients with features of both pemphigus and pemphigoid. We recommend that these patients be considered as having a dual diagnosis.

METHODS:

A review of the English language, peer-reviewed literature was conducted on patients described with features of pemphigus and pemphigoid. Available data on clinical profile, histology, immunopathology, treatment, follow-up and outcome were studied in 30 patients. They were divided into three groups: (1) bullous pemphigoid and pemphigus vulgaris, (2) mucous membrane or cicatricial pemphigoid and pemphigus vulgaris and (3) bullous pemphigoid and pemphigus foliaceus.

RESULTS:

In all three groups, most patients had a clinical phenotype resembling both diseases. In 17 patients with bullous pemphigoid and pemphigus vulgaris, 83% had a skin biopsy consistent with bullous pemphigoid, 70% had direct immunofluorescence studies typical of bullous pemphigoid and sera of 83% had antibodies typical of pemphigus vulgaris on indirect immunofluorescence. In 10 patients with mucous membrane or cicatricial pemphigoid and pemphigus vulgaris, a histology of mucous membrane pemphigoid was reported in 60% of the patients, direct immunofluorescence studies typical of mucous membrane pemphigoid were reported in 70% of the patients and in 80%, autoantibodies characteristic of pemphigus vulgaris were observed. In 3 patients with bullous pemphigoid and pemphigus foliaceus, the histologies were consistent with bullous pemphigoid, direct immunofluorescence was typical of pemphigus foliaceus and their sera had both autoantibodies. The majority of the 30 patients required long-term high-dose corticosteroids and immunosuppressive agents to control their disease. Three patients with bullous pemphigoid and pemphigus vulgaris (18%) died due to effects of prolonged immunosuppression.

CONCLUSION:

We characterize a group of patients who have clinical, histological and immunopathological features of bullous or mucous membrane or cicatricial pemphigoid with serological features of pemphigus. These patients did not achieve a prolonged clinical remission by conventional therapy. It is possible that early identification of these patients may improve their prognosis.

Ahmed is still a prominent member of the dermatology community. The Pan Arab League of Dermatologists gave him a lifetime achievement award in 2011, and he spoke several times at this year’s International Pemphigus & Pemphigoid Foundation’s Patient Conference, on the disease and treatment side effects.

We have tried to contact Ahmed and the editors of both Clinical Immunology and Dermatology, as well as the Centers for Medicare and Medicaid Services and the US Department of Justice. We will update this post with anything else we learn.

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