A Texas doctor has been sentenced to a decade in federal prison for his role in a massive healthcare fraud scheme. Dr. Jorge Zamora-Quezada was found guilty of falsely diagnosing patients to bill insurance companies for unnecessary procedures, amassing millions in ill-gotten gains.

The U.S. Department of Justice (DOJ) reported that Dr. Zamora-Quezada’s sentence includes three years of supervised release, along with the prison term. The scheme involved over $118 million in fraudulent claims, resulting in more than $28 million in payments from insurers [[1]].

During the trial,prosecutors successfully argued that Zamora-Quezada prioritized his financial gain by misdiagnosing patients and subjecting them to unnecessary medical interventions.

Assets Forfeited

As part of his sentence, Zamora-Quezada, 68, is being forced to forfeit approximately $28 million in assets.These include 13 real estate properties, a private jet, and a Maserati GranTurismo sports car.

The DOJ press release detailed the extent of Zamora-Quezada’s fraudulent activities:

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.
U.S. Department of Justice

The unnecessary treatments and tests, including injections, infusions, X-rays, and mris, carried potentially harmful and even deadly side effects. To facilitate the scheme, Zamora-Quezada fabricated medical records and misrepresented patients’ conditions to insurers.

Revoked Licenses and cover-up attempts

Zamora-Quezada, a licensed rheumatologist in Texas, Arizona, and Massachusetts, has had all his medical licenses revoked. Prosecutors also presented evidence that he attempted to conceal the fraud by falsifying patient records after receiving a federal grand jury subpoena. The scheme spanned nearly two decades and involved approximately $325 million [[1]].

In 2020, Zamora-Quezada was convicted on multiple counts, including conspiracy to commit health care fraud, health care fraud, and conspiracy to obstruct justice.

According to KRGV, his sentencing faced delays due to disagreements between prosecutors and defense attorneys regarding the number of victims and the total amount of money stolen.

Toxic Work Habitat

Zamora-Quezada was also accused of creating a hostile work environment for his clinic’s employees,many of whom were on work visas. He allegedly threatened to fire them and revoke their visas if they did not meet procedure quotas or spoke out against him.

The DOJ revealed further details about the cover-up attempts:

Testimony at trial established that zamora-Quezada told employees to ‘aparecer’ the missing records – ‘to make them appear,’
U.S. Department of Justice

Former employees testified about being sent to a dilapidated barn to retrieve records infested with feces, urine, rodents, and termites.

Other rheumatologists in Texas’ Rio Grande Valley testified that they encountered hundreds of patients who had been misdiagnosed with rheumatoid arthritis by Zamora-Quezada. One doctor stated that it would be “obvious” to “most” doctors that these patients did not have the condition.

Prosecutors highlighted the debilitating side effects suffered by patients due to the false diagnoses and medications, including strokes, necrosis of the jawbone, hair loss, liver damage, and severe pain.

Patients testified about the devastating impact of Zamora-Quezada’s actions:

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,
Patient Testimony, U.S. Department of Justice

Another patient’s mother described her child as a “lab rat,” while other patients felt like they were “living a life in the body of an elderly person.”

Matthew R. Galeotti, head of the DOJ’s criminal division, condemned Zamora-Quezada’s actions:

Dr. Zamora-Quezada funded his luxurious lifestyle for two decades by traumatizing his patients, abusing his employees, lying to insurers and stealing taxpayer money. His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctor.
Matthew R. Galeotti, U.S. Department of Justice