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A Detroit-based doctor is facing trouble on two fronts: federal charges and the state suspension of his medical license related to drug prescribing practices at his office.

Dr. Asm Akter Ahmed's license was suspended by the Michigan Department of Licensing and Regulatory Affairs on April 6. The state alleges that Ahmed, in 2017, was a "top prescriber" of a muscle relaxant, carisoprodol, and promethazine with codeine syrup, both of which, it says, are "commonly abused and diverted" to users without prescriptions for them. 

Days after the state suspended Ahmed's license, on April 12, the feds unsealed an indictment against Ahmed, among others, for "multiple offenses" related to health care fraud, along with distributing and conspiring to distribute controlled substances, all of which were opioids.

The U.S. Attorney for Detroit, in a news release, explained the alleged scheme: Fraudulent billings to Medicare, Medicaid and Blue Cross Blue Shield "for controlled substances that were dispensed and high-priced medications that were not dispensed."

Those fraudulent billings produced at least $5 million in profits, the feds allege. 

"As one part of the scheme to defraud, the defendants billed insurance companies for providing medications to people who had died prior to the claimed date of delivery," the feds claim. 

The feds allege that another doctor, Fouzi Ramouni, 42, of Madison Heights, recruited and paid Medicare and Medicaid beneficiaries to visit Dr. Akter Ahmed, 58, of Hamtramck.

"Without a genuine examination or a showing of medical necessity, Dr. Ahmed prescribed opioids for these patients, including Carisoprodol and promethazine codeine syrup. In addition to prescribing opioids, Dr. Ahmed also prescribed unnecessary and expensive medications," according to the news release.  

The state, in its administrative complaint against Ahmed, claims that more than 90 percent of the scripts Ahmed wrote between Jan. 1, 2015, and Sept. 30, 2017, were for promethazine with codeine syrup, which accounted for 58 percent, and for the muscle relaxer, which accounted for 35 percent. 

In the second quarter of 2016, Ahmed was the 34th most common prescriber in Michigan of the muscle relaxed, and the 30th most common prescriber of promethazine with codeine syrup. But in the second half of 2016 and in the four quarters of 2017, he never dropped below fifth in either category.

Ahmed, according to the complaints, attributed that jump in the third quarter of 2016 to an "experiment" he started to address the opioid epidemic, wherein he would encourage patients to obtain medical marijuana rather than opioids, then prescribe the promethazine with codeine to treat the coughing that resulted from smoking the pot.

The jump in prescriptions related to the muscle relaxer, he said, owed to an attempt to wean patients off benzodiazepines such as Xanax. 

Roughly 57 percent of Ahmed's patients paid cash for these controlled substance prescriptions, "several times the state average of 10 percent." The state believe this "suggests that prescriptions were filled for illegitimate purposes."

It wasn't until April 3, 2017, that Ahmed registered with MAPS, the Michigan Automated Prescription System, according to the state. MAPS allows doctors and pharmacists to see a patient's history with prescribed controlled substances.

But Ahmed, per the complaint, did not document in patients' medical records what other drugs they'd been prescribed, and what he found in the MAPS reports. Nor did he obtain past medical records or screen urine for drugs, and did not always document what was prescribed.

Ahmed, per the complaint, has 30 days to answer it in writing, and to "show compliance with all lawful requirements for retention of the license." Failure to answer the complaint in writing "is an admission of all complaint allegations" in the state's eyes. If no answer does arrive, LARA will pursue further discipline.

 

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