Texas Rheumatologist Jailed for 10 Years Over $118M Health Care Fraud Scheme
TL/DR –
A Texas-based rheumatologist, Jorge Zamora-Quezada, has been sentenced to 10 years in prison and three years of supervised release for a health care fraud scheme that involved over $118 million in false claims. He falsely diagnosed patients with chronic illnesses to bill for tests and treatments the patients did not need. To support his expensive lifestyle, he fabricated medical records, lied about patients’ conditions to insurers, and administered unnecessary treatments.
Texas Rheumatologist Sentenced for $118 Million Health Care Fraud
Jorge Zamora-Quezada, a Texas-based rheumatologist, has been sentenced to 10 years in prison for a health care fraud scheme, where he falsely diagnosed patients with chronic illnesses to bill unnecessary treatments and tests. Found guilty of a $118 million fraud with insurers paying over $28 million, Zamora-Quezada was convicted of conspiracy to commit health care fraud, health care fraud, and conspiracy to obstruct justice post a 25-day trial.
The doctor, who received a federal grand jury subpoena, falsified patient records to back up his false diagnoses. Along with his prison sentence, Zamora-Quezada has also been ordered to forfeit $28,245,454, including 13 real estate properties, a jet, and a Maserati GranTurismo.
Unnecessary Treatment and Toxic Medication
Zamora-Quezada falsely diagnosed patients with rheumatoid arthritis and gave them toxic medications to defraud Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield. These false diagnoses led patients to believe they had a lifelong, incurable condition requiring regular treatments. The fraudulent doctor administered unnecessary treatments, ordered pointless tests, and fabricated medical records to get payments for these services.
Matthew R. Galeotti, Justice Department’s Criminal Division Head, condemned Zamora-Quezada’s actions stating, “His depraved conduct represents a profound betrayal of trust.” He further warned that medical professionals causing harm for personal profits would be aggressively pursued.
The Devastating Effects of the Fraud
Special Agent in Charge Jason E. Meadows of the U.S. HHS-OIG emphasized the need to investigate such frauds to protect vulnerable individuals and the integrity of the federal health care system. Hundreds of Zamora-Quezada’s patients suffered debilitating side effects due to his false diagnoses and powerful medications. Side effects ranged from strokes, necrosis of the jawbone, severe pain, to hair and liver damage.
Former employees revealed Zamora-Quezada’s tyrannical behavior, including his imposition of strict quotas for procedures, threats to employees on J-1 visas, and tactics to obstruct insurer audits by fabricating patient files.
Proceeds Used for Lavish Lifestyle
Zamora-Quezada used the proceeds from his crimes to fund an extravagant lifestyle, including numerous real estate properties across the country and in Mexico, a jet, and a Maserati.
The case was investigated by FBI, HHS-OIG, Texas HHS-OIG, and the Texas Medicaid Fraud Control Unit, with assistance from the Defense Criminal Investigative Service. The Criminal Division’s Fraud Section and Assistant U.S. Attorney Laura Garcia prosecuted the case.
For more information about combatting health care fraud, visit the Health Care Fraud Unit’s website at www.justice.gov/criminal-fraud/health-care-fraud-unit.
—
Read More Health & Wellness News ; US News