A Texas rheumatologist, Jorge Zamora-Quezada, M.D., 68, of Mission, was sentenced to 10 years in federal prison and three years of supervised release for orchestrating a massive healthcare fraud scheme exceeding $118 million in false claims. The scheme led insurers to pay over $28 million for unnecessary tests and treatments based on fabricated chronic illness diagnoses.
Following a 25-day trial, Zamora-Quezada was convicted of conspiracy to commit healthcare fraud, multiple counts of healthcare fraud, and conspiracy to obstruct justice. In addition to his prison term, he was ordered to forfeit assets including 13 properties, a private jet, and a Maserati GranTurismo, totaling over $28 million.
Evidence revealed that Zamora-Quezada falsely diagnosed patients with rheumatoid arthritis and administered toxic, unnecessary medications to defraud Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield. He convinced patients they had incurable chronic conditions requiring ongoing treatment, then ordered unneeded injections, infusions, imaging tests, and procedures with serious side effects, including strokes and liver damage.
To secure payment, Zamora-Quezada falsified medical records and lied to insurers about patient conditions. Other local rheumatologists testified that many patients diagnosed by Zamora-Quezada did not have rheumatoid arthritis. Patients suffered debilitating effects, with some unable to perform basic daily tasks and describing their lives as lost to pain and toxic treatment.
Former employees described a workplace dominated by fear and manipulation, with Zamora-Quezada enforcing strict quotas for unnecessary procedures. He intimidated and fired staff who resisted, exploiting vulnerable workers on J-1 visas. To obstruct insurer audits, he fabricated patient files, including using employee ultrasounds as fake patient documentation.
The investigation was led by the FBI, HHS Office of Inspector General, Texas Medicaid Fraud Control Unit, and other agencies. Prosecutors emphasized that Zamora-Quezada’s fraudulent actions betrayed patient trust and wasted taxpayer money.
“His depraved conduct represents a profound betrayal of trust toward vulnerable patients,” said Matthew R. Galeotti, head of the DOJ Criminal Division. The case stands as a stern warning that healthcare professionals who exploit patients and taxpayers will be held accountable.
