Texas Rheumatologist Sentenced to 10 Years in Jail for Falsely Diagnosing Patients in $118M Fraud Scheme
A Texas rheumatologist who participated in a $118 million healthcare fraud scheme that involved falsely diagnosing patients with chronic illnesses in order to bill Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield for unnecessary tests and treatments has been sentenced to 10 years in jail, 3 years of supervised release, and must forfeit $28,245,454, which includes 13 real estate properties, a jet, and a Maserati GranTurismo. Felony convictions also result in mandatory exclusion from federal healthcare programs.
Over two decades, Jorge Zamora-Quezada, M.D., 68, of Mission, Texas, falsified patient records to support rheumatoid arthritis diagnoses. Patients were led to believe that they had a lifelong, incurable health condition that required regular treatments at Zamora-Quezada’s medical practice. The patients were administered toxic medications and were required to undergo further tests, including injections, infusions, x-rays, and MRIs, the costs of which were fraudulently billed to insurers. Some of the treatments were harmful and caused potentially deadly side effects. Some of his patients suffered strokes, necrosis of the jawbone, hair loss, liver damage, and severe and debilitating pain as a result of the treatments he administered.
At the trial, rheumatologists testified that they had seen hundreds of patients who had received a rheumatoid arthritis diagnosis from Zamora-Quezada, when it was clear that they did not have the condition. Former employees testified that they had strict quotas for procedures, resulting in a climate of fear, with the staff threatened if they failed to meet their quotas. Staff members were also hired who could be easily intimidated, such as individuals with J-1 visas who would lose their right to live and work in the US if they lost their jobs.
In addition to falsifying patient records, Zamora-Quezada fabricated missing patient files to obstruct audits by insurers, and in some cases, took ultrasounds of employees and used them as documentation in patient records. Zamora-Quezada used the proceeds of the fraud scheme to purchase real estate in the United States and Mexico, a luxury car, a private jet, and fund a lavish lifestyle.
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“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. “His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctors.”
Following a 25-day trial, Zamora-Quezada was convicted of one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud, and one count of conspiracy to obstruct justice. “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,” said Galeotti.
