Patients endured unnecessary treatments and debilitating side effects after a Texas rheumatologist falsely diagnosed them with rheumatoid arthritis to bill health care insurers for millions of dollars.
A Texas rheumatologist was sentenced to 10 years in prison and three years of supervised release for conducting a $118 million health care fraud scheme that involved falsely diagnosing patients with chronic illnesses to bill for tests and treatments that the patients did not need.
The Department of Justice said last week that Jorge Zamora-Quezada, M.D., 68, of Mission, also falsified patient records to support the false diagnoses after receiving a federal grand jury subpoena. Following a 25-day trial, Zamora-Quezada was convicted of one count of conspiracy to commit health care fraud, seven counts of health care fraud, and one count of conspiracy to obstruct justice. In addition to his prison term, Zamora-Quezada was ordered to forfeit $28 million, including 13 real estate properties, a jet, and a Maserati GranTurismo.
Zamora-Quezada falsely diagnosed his patients with rheumatoid arthritis and administered toxic medications to defraud Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield, according to the evidence presented at the trial. The fraudulent diagnoses made his patients believe that they had a lifelong, incurable condition that required regular treatment at his offices. After falsely diagnosing his patients, Zamora-Quezada administered unnecessary treatments and ordered unnecessary testing on them, including a variety of injections, infusions, x-rays, MRIs, and other procedures—all with potentially harmful and even deadly side effects. To receive payment for these expensive services, Zamora-Quezada fabricated medical records and lied about the patients’ condition to insurers.
Other rheumatologists in the Rio Grande Valley testified at trial that they saw hundreds of patients previously diagnosed with rheumatoid arthritis by Zamora-Quezada who did not have the condition, prompting one physician to explain that for “most” it was “obvious that the patient did not have rheumatoid arthritis.”
Zamora-Quezada’s false diagnoses and powerful medications caused debilitating side effects on his patients, including strokes, necrosis of the jawbone, hair loss, liver damage, and pain so severe that basic tasks of everyday life, such as bathing, cooking, and driving, became difficult. As one patient testified, “Constantly being in bed and being unable to get up from bed alone, and being pumped with medication, I didn’t feel like my life had any meaning.” One mother described how she felt that her child served as a “lab rat,” and others described abandoning plans for college or feeling like they were “living a life in the body of an elderly person.”
Former employees detailed how Zamora-Quezada imposed strict quotas for procedures, leading to a climate of fear. Zamora-Quezada referred to himself as the “eminencia”—or eminence, threw a paperweight at an employee who failed to generate enough unnecessary procedures, hired employees he could manipulate because they were on J-1 visas and their immigration status could be jeopardized if they lost their jobs, and fired those who challenged him. Testimony also revealed Zamora-Quezada obstructed insurer audits by fabricating missing patient files, including by taking ultrasounds of employees and using those images as documentation in the patient records.
“Dr. Zamora-Quezada funded his luxurious lifestyle for two decades by traumatizing his patients, abusing his employees, lying to insurers, and stealing taxpayer money,” said Matthew R. Galeotti, head of the Justice Department’s Criminal Division, in an announcement. “His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctors. Today’s sentence is not just a punishment—it’s a warning. Medical professionals who harm Americans for personal enrichment will be aggressively pursued and held accountable to protect our citizens and the public fisc.”