For 18 years, Jorge Zamora-Quezada, a physician based in McAllen, Texas, enjoyed a lavish lifestyle—flying in private jets, driving luxury vehicles, and purchasing high-end clothing—at the mercy of his patients who underwent numerous medical treatments upon false diagnosis. Zamora-Quezada and his co-conspirators traveled between the Rio Grande Valley and San Antonio conducting unwarranted chemotherapy and other fraudulent, repetitive, and excessive medical procedures on young, elderly, and disabled patients.
A fraud scheme of this magnitude bears substantial proceeds that would raise a red flag upon federal investigation. Zamora-Quezada and his co-conspirators, in full knowledge of this risk, dissipated and concealed the location of the fraud proceeds through an impermissible investment system. Zamora-Quezada bought several commercial and residential properties in the United States and Mexico and rented the properties to individuals and entities to give a false appearance of legitimate wealth and income. His co-conspirators used his real estate ventures to launder money through financial institutions in Mexico. After eighteen years of disgracing the medical profession and committing unthinkable betrayal to patients who trusted and presumed his integrity, Zamora-Quezada has been charged with several counts of health care fraud as well as conspiracy to commit money laundering, according to an article released by the U.S. Attorney’s Office for the Southern District of Texas.
Unfortunately, this case not an anomaly. In 2013, federal agents arrested a doctor in Michigan for deliberately misdiagnosing patients with cancer and profiting from “treating” them. In 2015, a hematologist-oncologist Detroit was sentenced to 45 years after intentionally misdiagnosing patients with cancer and administering chemotherapy. In 2015, a former hospital CFO and two surgeons were charged with medical and billing fraud after referring thousands of patients for spinal surgeries cumulatively amounting to over $600 million.
Physicians and hospitals are not the only ones that have recently been charged with high scale fraud. Pharmacies and agencies are no strangers to fraud and often play a significant role in covering it up. In January of this year, a pharmacy employee in New Jersey was charged with heath care fraud conspiracy for falsely billing public and private insurers for medications that were never dispensed to patients.
The common aphorism that physicians are ‘in the pockets’ of pharmacies and medicinal agencies is not far from the truth in some cases. As a recent example, an owner of several pharmacies in Miami was charged with fraud after using physician recruiters to bring Medicare beneficiaries to his pharmacies. The recruiter physicians would write fraudulent prescriptions and the pharmacy owner would pay them kickbacks. Over the past decade, federal law enforcement has made combating criminal health care fraud one of their highest priorities due to economic losses suffered by the government and private insurers and in hopes of protecting American patients.
Medicare and Medicaid continue to be attractive targets for abuse and fraud. Private insurers look for remission against perpetrators of fraud since they pay the bulk of the bills. Congress has worked to develop a statutory and regulatory scheme in favor of insurers that imposes sanctions on any person or entity that commits health care fraud. In addition, the government may bring criminal charges under the False Claims and False Statement Act. The recent efforts are reflective of Congress’ previous passage of the Health Insurance Portability and Accountability Act (HIPAA) which established a stable source of funding to combat fraud and became the first federal statute to regulate private health care and increase the government’s ability to fight against fraud.
Health care takes a turn for the worst when doctors assume the role of crooked businessmen and pharmacies engage in underhanded practices putting the American people in jeopardy. Statutory and regulatory schemes intended to punish perpetrators of fraud, although costly (costing the American people $36 billion a year) is the only current form of remission accessible to the government, private insurers, and American patients.
For insurers who suspect a fraudulent health care scheme, contact the knowledgeable legal team at Parker, LLP Attorneys at Law. With a proven track record in detecting fraud, our insurance fraud attorneys are here to help stop your company from paying unnecessary claims.