A Texas doctor who falsely diagnosed his patients with chronic illnesses in a $118 million scheme has been sentenced to prison.
The rheumatologist, Jorge Zamora-Quezada, M.D., 68, of Mission, was sentenced to 10 years in prison and three years of supervised release.
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He 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 $28,245,454, including 13 real estate properties, along with a jet and a Maserati GranTurismo.
What happened
According to the evidence presented at trial, Zamora-Quezada falsely diagnosed his patients with rheumatoid arthritis and administered toxic medications in order to defraud Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield.
The fraudulent diagnoses made the defendant’s 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’ conditions to insurers. Evidence at trial showed that Dr. Zamora-Quezada repeatedly misdiagnosed patients in order to defraud insurers and enrich himself. 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’s obstruction of insurer audits by fabricating missing patient files, including by taking ultrasounds of employees and using those images as documentation in the patient records. Testimony at trial established that Zamora-Quezada told employees to “aparecer” the missing records — “to make them appear.” Former employees also recounted being sent to a dilapidated barn to attempt to retrieve records.
There, files were saturated with feces and urine, and rodents and termites infested not only the records but also the structure.