For nearly 20 years, a Texas doctor falsely diagnosed patients as having a chronic disease, administered unnecessary, toxic treatments and filed more than $118 million in fraudulent health insurance claims to fund his lavish lifestyle, which included a private jet, luxury cars and high-end properties, prosecutors said.
The doctor, Jorge Zamora-Quezada, 68, of Mission, Texas, was sentenced to 10 years in prison this week, according to the Justice Department.
From 2000 to 2018, he falsely diagnosed patients with rheumatoid arthritis and administered dangerous, medically unnecessary treatments to defraud federal and private health insurance companies, the Justice Department said.
Rheumatoid arthritis is a chronic disease that causes a person’s immune system to attack healthy tissue. Some of Mr. Zamora-Quezada’s patients were as young as 13, the Justice Department said.
Mr. Zamora-Quezada’s medical license was canceled in 2021, according to Texas Medical Board records.
His scheme funded what prosecutors described in court documents as his “lavish and opulent lifestyle,” with properties across the United States and Mexico, as well as a private jet and a Maserati that he used to travel between his offices in the Rio Grande Valley and San Antonio.
Mr. Zamora-Quezada had two luxury penthouse apartments in Puerto Vallarta, Mexico; condominiums in San Diego, Aspen, Colo., and Punta Mita, Mexico; and multiple homes and commercial properties in Texas, according to court records.
Matthew R. Galeotti, head of the Justice Department’s criminal division, said Mr. Zamora-Quezada’s “depraved conduct” represented a “profound betrayal of trust” between patients and their doctors.
Randy Crane, the U.S. chief district judge for the Southern District of Texas, sentenced Mr. Zamora-Quezada to 120 months in prison followed by three years of supervised release. Mr. Zamora-Quezada was also ordered to pay $28,245,454 in restitution, according to court documents.
His scheme defrauded Medicare, Medicaid, TRICARE and Blue Cross Blue Shield, which together paid out more than $28 million in false claims, according to prosecutors.
A lawyer listed in court records for Mr. Zamora-Quezada did not immediately respond to requests for comment on Sunday.
After a 25-day trial, Mr. Zamora-Quezada was convicted in January 2020 of one count of conspiracy to commit health care fraud, seven counts of health care fraud and one count of conspiracy to obstruct justice.
According to a criminal complaint filed in 2018, Mr. Zamora-Quezada falsely diagnosed many patients with rheumatoid arthritis and subjected them to testing, chemotherapy drugs, hourslong intravenous infusions and other “excessive, repetitive and profit-driven” procedures.
Patients suffered strokes, necrosis of the jawbone, hair loss, liver damage and debilitating pain that made daily, basic tasks difficult, federal prosecutors said in a news release. It was not known how many patients in total were misdiagnosed.
Mr. Zamora-Quezada hired staff members whom he could manipulate because of their immigration status and imposed strict quotas for the procedures, the Justice Department said.
Mr. Zamora-Quezada dismissed patients from his practice who questioned him and hid thousands of patients’ records from insurers and other doctors in a dilapidated barn in the Rio Grande Valley, where they were found covered with feces and urine, rodents and termites, the complaint said.
Additionally, prosecutors said, Mr. Zamora-Quezada falsified or fabricated patient files and records, including by taking ultrasounds of employees that he used as misleading documentation for insurer audits.
The post Texas Doctor Who Filed $118 Million in Fraudulent Medical Claims Gets 10 Years in Prison appeared first on New York Times.
