The 68-year-old was convicted on multiple charges that included the false diagnosis of hundreds of patients.
Texas-based rheumatologist Dr Jorge Zamora-Quezada has been sentenced to 10 years in federal prison for orchestrating a large-scale health care fraud scheme.
The elaborate hoax involved the false diagnosis of hundreds of patients and the submission of more than US $118 million (about AU$184 million) in fraudulent claims to federal and private health insurers.
According to a statement from the US Department of Justice’s Office of Public Affairs, Dr Zamora-Quezada, 68, was convicted of conspiracy to commit health care fraud, multiple counts of health care fraud and conspiracy to obstruct justice following a 25-day trial.
In addition to the prison sentence, he will serve three years of supervised release and was ordered to forfeit more than US$28 million (about AU$43.6 million) in assets –including 13 real estate properties, a private jet and a luxury Maserati GranTurismo sports car.
According to trial evidence, Dr Zamora-Quezada routinely misdiagnosed patients with chronic, lifelong autoimmune conditions such as rheumatoid arthritis in order to justify costly and medically unnecessary treatments.
These treatments included immunosuppressive medications and invasive diagnostic procedures, which exposed patients to serious health risks — including liver damage, strokes, jawbone necrosis and long-term disability.
The scheme targeted Medicare, Medicaid, TRICARE and Blue Cross Blue Shield, among others, and was supported by falsified medical records and fabricated diagnostic imaging. Patients testified that they were misled into believing they had incurable diseases, resulting in significant psychological and physical trauma.
Matthew R Galeotti, head of the Justice Department’s Criminal Division, was scathing in his comments after the conviction.
“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 Mr Galeotti.
“His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctors. 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.”
Fellow rheumatologists in the Rio Grande Valley testified at trial that they saw hundreds of patients previously diagnosed with rheumatoid arthritis by Dr 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.”
Dr 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”.
“Through the false diagnoses and excessive false billing, Dr. Zamora-Quezada abused both patient trust and public resources,” said Special Agent in Charge Jason E Meadows of the US Department of Health and Human Services Office of Inspector General.
“It is imperative to investigate and address this form of fraud – not only to protect vulnerable individuals from harm but to uphold the integrity of the federal health care system and safeguard the use of public funds.”
Evidence at trial established that Dr. Zamora-Quezada falsely diagnosed patients to defraud insurers and enrich himself.
Former employees detailed how Dr Zamora-Quezada imposed strict quotas for procedures, leading to a climate of fear.
Dr Zamora-Quezada referred to himself as the “eminencia” (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 jeopardised if they lost their jobs and fired those who challenged him.
Testimony also revealed Dr 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 Dr Zamora-Quezada told employees to “aparecer” (make them appear) the missing records. Other employees also recounted being sent to a dilapidated barn to attempt to retrieve records. There, files were saturated with faeces and urine, rodents and termites that infested not only the records but also the structure.
Special agent in charge Aaron Tapp, of the FBI’s San Antonio Field Office said the case was about more than fraud.
“This case was not only a concern to us because of the financial loss — the physical and emotional harm suffered by the patients and their families was alarming and profound,” he said.
“We hope this significant sentence will help bring closure to the many victims in this case.”
