Texas Rheumatologist Sentenced to 10 Years for $118M in Fraudulent Healthcare Claims

Texas Rheumatologist Sentenced to 10 Years for $118M in Fraudulent Healthcare Claims

The U.S. Department of Justice (DOJ) announced that Texas rheumatologist Dr. Jorge Zamora-Quezada had been sentenced to 10 years’ imprisonment in connection with the submission of over $118 million in fraudulent healthcare claims, following a 25-day trial where he was convicted of healthcare fraud and ordered to forfeit $28 million, including 13 properties, a jet, and a Maserati.  The announcement was made May 21, 2025.

According to the evidence presented at trial, in order to enrich himself, for two decades Dr. Zamora-Quezada falsely diagnosed his patients with rheumatoid arthritis and administered unnecessary toxic medications, resulting in both patient harm and fraud on the Medicare, Medicaid, and TRICARE government healthcare programs – as well as private insurers like Blue Cross Blue Shield. In addition to being made to believe they had an incurable condition and the accompanying emotional distress that caused, Zamora-Quezada’s patients suffered debilitating physical harms as a result of the unnecessary treatments and testing to which they were subjected, including injections, infusions, X-rays, MRIs, and other procedures.

Among the litany of harms caused by the administration of the powerful immunosuppressant medications were strokes, necrosis of the jawbone, hair loss, liver damage, and severe pain that interfered with the basics of everyday life for Zamora-Quezada’s patients.

In chilling testimony at trial, patients recounted feeling that life had lost its meaning after being pumped with medication and constantly bedridden. Young patients testified about abandoning plans for college and feeling like they were in the body of an elderly person. 

Testimony from former employees revealed the modus operandi Dr. Zamora-Quezada employed that allowed him to avoid detection of his healthcare fraud scheme for two decades, including hiring employees on J-1 visas whose immigration status depended on keeping their job, firing employees who challenged him, and intimidating and threatening employees who failed to meet strict quotas for unnecessary procedures – even once throwing a paperweight at one.

According to former employees, Dr. Zamora-Quezada had them fabricate patient files and records (including fabricated ultrasounds and diagnostic imaging) in order to obstruct audits by insurers. In a bout of toxic narcissism, Zamora-Quezada was also reputed to have regularly referred to himself in the third person as “eminence.”

It is notable that this case did not originate with a whistleblower, nor does it appear that any of Dr. Zamora-Quezada’s fellow rheumatologists in the Rio Grande Valley spoke up and reported him, despite testifying at trial that they had seen a number of Dr. Zamora-Quezada’s patients who clearly did not have rheumatoid arthritis. Instead, according to the DOJ press release, the investigation of Dr. Zamora-Quezada originated as a result of work done by DOJ’s Data Analytics Team, presumably because of some data anomaly relating to Dr. Zamora-Quezada. 

When the gig was up and the feds came knocking, serving him with a federal grand jury subpoena, Dr. Zamora-Quezada doubled down and attempted to cover up his actions by falsifying patient records to support false diagnoses, thereby earning himself a conviction for obstruction of justice at trial. 

Zamora-Quezada joins a sad history of doctors who were convicted for flagrantly violating their Hippocratic oaths and preying on vulnerable patients to fund a lavish lifestyle, including a Westlake cardiologist who was convicted of performing unnecessary catheterizations, tests, and stent insertions, causing unnecessary coronary artery bypass surgery, and a former Chesapeake OB/GYN sentenced to 59 years for performing irreversible hysterectomies, improper sterilizations, and other medically unnecessary surgeries.  In DOJ’s press release announcing the conviction, Matthew Galeotti, head of the DOJ Criminal Division, said it best when he said that Dr. Zamora-Quezada’s “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.”

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Mary Inman, Esq.

Mary Inman is a partner and co-founder of Whistleblower Partners LLP, a law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs. Mary and her colleagues have pioneered a series of successful whistleblower cases against prominent health insurers, hospitals, provider groups, and vendors under the False Claims Act alleging manipulation of the risk scores of Medicare Advantage patients. Mary is a recognized expert and frequent author, commentator, and speaker on frauds in the healthcare industry, particularly those exposed by whistleblowers. Mary is a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

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