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Texas case shows health care fraud is not uncommon

On Behalf of | Aug 22, 2018 | Uncategorized |

In May 2018, a Texas rheumatologist was indicted on fraud charges after patients began raising concerns about the treatments he was providing. This kind of case is not uncommon; fraud makes up about 3 percent of the trillions spent on health care in our country.

What happened

A joint federal and local task force began investigating Dr. Jorge Zamora-Quezada of McAllen, Texas, after patient complaints began surfacing. In some cases, other doctors also questioned the kind of care the rheumatologist was providing. The investigation found that Zamora-Quezada was falsely diagnosing patients, giving them treatment they did not need, hiding records from Medicare and concealing records from other doctors.

High living

The task force announced that the rheumatologist was being indicted for fraud that partly involved $240 million in “fraudulent statements,” meaning false claims he submitted to health care programs. The doctor kept $50 million for himself, which accounted for his private jet, his Maserati and his many real estate properties both in the U.S. and Mexico. The Department of Justice is currently seeking the forfeiture of those possessions.

Lengthy investigations

People who are being investigated for fraud and other white-collar offenses are wise to seek legal counsel at the outset. Investigations can take months, even years. In the indictment, Zamora-Quezada is accused of participation in an international money laundering scheme. He sent funds to a money exchange house, which, in turn, spread it among various Mexican financial institutions.

Known to the medical community

The rheumatologist has a questionable history in the medical profession. He was publicly reprimanded by the Texas Medical Board for previous infractions. However, it appears that he is closing out his medical career. Dr. Zamora-Quezada has been charged with five counts of health care fraud, one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. Yet his case is far from unusual. According to data compiled by the National Health Care Anti-Fraud Association, the annual cost of health care fraud in the U.S. is about $68 billion.


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