Case Summary
A world-renowned dermatologist specializing in blistering diseases who faced disciplinary action in New York State following his federal criminal conviction in Massachusetts. The case involved allegations that he altered medical records to help Medicare patients receive coverage for expensive treatments (IVIg) for autoimmune blistering diseases.
The underlying issue stemmed from Medicare’s 1997 policy change that would only cover IVIg treatment (costing ~$17,000 per injection) for pemphigus patients but not for pemphigoid patients, despite the physician’s belief that both conditions warranted the same treatment. Federal prosecutors alleged that the doctor backdated medical records to make it appear that pemphigoid patients also had pemphigus to secure Medicare coverage.
He pleaded guilty to Obstruction of Criminal Investigations of Health Care Offenses (18 USC § 1518) and was sentenced to 2 years’ probation (6 months home confinement), 400 hours of free medical service, $20,000 fine, and forfeiture of $2.9 million. The Massachusetts and North Dakota medical boards also took disciplinary action.
Notably, Medicare eventually reversed its position in 2002 and began covering IVIg for pemphigoid patients, validating the doctor’s medical judgment. The New York hearing committee, while sustaining the charges, imposed no additional punishment, recognizing his exceptional contributions to medicine, his genuine remorse, and that patients received the treatments they were billed for without harm.
Case Analysis
Effective Date: August 6, 2010
Type of Doctor: Dermatologist (MD) – specialist in autoimmune blistering diseases
Disposition Type: Hearing Committee Decision (expedited hearing under Public Health Law Section 230(10)(p))
How many total charges? 5 specifications of professional misconduct
What specifications of charges were alleged?
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- First Specification: Violation of Education Law §6530(9)(a)(ii) – being convicted of committing an act constituting a crime under federal law
- Second Specification: Violation of Education Law §6530(9)(b) – found guilty of professional misconduct by the Massachusetts Board of Registration in Medicine
- Third Specification: Violation of Education Law §6530(9)(b) – found guilty of professional misconduct by the North Dakota State Board of Medical Examiners
- Fourth Specification: Violation of Education Law §6530(9)(d) – license suspended by Massachusetts Board
- Fifth Specification: Violation of Education Law §6530(9)(d) – license suspended by North Dakota Board
How many patients were involved in each charge? Multiple Medicare patients with pemphigoid who needed IVIg treatment (specific number not quantified in the record, but the case involved systemic billing practices from 1997-2002)
Which charges was the licensee guilty of (either via hearing or negotiated consent)? All five specifications were SUSTAINED by unanimous vote (3-0) of the Hearing Committee
Which charges was the licensee not guilty of? None – all charges were sustained
Outcome/Penalties (specific to this case):
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- No additional punishment was imposed despite all charges being sustained
- No license suspension, revocation, or restrictions
- No monetary fines from New York State
- The Doctor is allowed to continue practicing without limitations
Rationale for No Additional Punishment:
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- Respondent showed genuine remorse and contrition
- Already sufficiently punished by federal court ($2.9M forfeiture, probation, fine)
- Medicare eventually validated the physician’s treatment approach in 2002
- No venal (greedy) motive – acted to help patients, not for personal gain
- Patients received the treatments billed and were helped by them
- The doctor’s exceptional contributions to medicine and patient care
- Recognition that limiting his practice would harm future patients needing specialized care
Source
https://apps.health.ny.gov/pubdoh/professionals/doctors/conduct/factions/PhysicianDetailsAction.action?finalActionId=8047