Defense rests in Zamora Quezada healthcare fraud trial

McALLEN — The defense for Dr. Jorge Zamora Quezada, the rheumatologist on trial on charges of healthcare fraud, rested their case Friday afternoon, inching closer to a conclusion.

The attorneys for the government and the defense will now deliver their closing arguments next week when the trial resumes Monday, after which deliberations are expected to begin.

Zamora Quezada, a local rheumatologist, is accused of participating in a scheme to defraud health insurers by misdiagnosing and over-treating patients.

He is on trial with three co-defendants which include his wife, Meisy Zamora, and two of their employees, Estella Santos Natera and Felix Ramos. They are accused of also participating in the scheme which allegedly included tampering with medical records and money laundering to conceal the source of the funds they made from the alleged scheme.

The attorneys for the doctor and the three co-defendants wrapped up with testimony from an expert statistician and two employees of Zamora Quezada’s clinic.

The statistician, Sergio Garcia, was questioned by defense attorney Stephen Lee over his review of claims data the clinic submitted to insurers from 2006 to 2012 and 2013 to 2018.

Looking at Medicare data, he said data showed that about a third of beneficiaries with a principal diagnosis of rheumatoid arthritis, only received diagnostic services as opposed to medical treatment.

Garcia also looked at how often rheumatologists disagreed with each other’s diagnoses. Although there were several times that rheumatologists disagreed with Zamora Quezada, the other doctors often disagreed with each other as well.

There were also times when a patient was treated for rheumatoid arthritis by another doctor but later went to Zamora Quezada who did not treat them for the condition.

Lee also addressed the allegation that employees were expected to order the same set of procedures for each patient’s first visit, another set of procedures for each patient’s second visit, and another set of procedures for each patient’s third visit.

Garcia testified that the data from different insurers showed that not every patient was billed for the same procedures.

There wasn’t a single test that every new patient received, Garcia testified, and there wasn’t a single new patient that received every test.

Throughout all of their visits, of the 52 labs available, the most that any patient received was 34.

On cross examination, the attorney for the government, Jacob Foster, tried to show the data was flawed when looking at how often rheumatologists agreed or disagreed with each other.

Foster pointed out that in one comparison between two rheumatologists, the physicians shared more patients than Garcia had shown in his charts.

He also pointed out that in some charts presented by the defense, the data only included payment information for some diagnosis codes but not others.

Earlier in the day, the jury heard from a current employee who currently handles patient records but first began working at the clinic in the billing department.

She testified that before claims were submitted to insurers, they were first sent to a clearinghouse that checked it for errors.

When asked about the number of claims submitted only a daily basis, she said it was an average of 70 to 80 per day among Zamora Quezada, another doctor and a physician assistant.

Upon cross examination by the attorney for the government, Rebecca Yuan, the employee said that Estella Natera, one of the co-defendants, was her supervisor and was in charge of submitting the claims to the clearing house.

She also acknowledged that there were times when there were more than 100 claims submitted in one day.

The last witness was a former radiology supervisor for the clinic.

She testified that they did not have daily quotas for the number of patients they had to see in a day but said her department kept a daily count to keep track of the machine’s for purposes of preventive maintenance.

In fact, she said, there were days when they had zero patients who received MRIs.

She also spoke highly of Zamora Quezada as a patient of his, recounting a time she went to see him because of shortness of breath.

Zamora Quezada informed her X-ray was abnormal and referred her for a CAT scan that found a malignant tumor.

If it wasn’t for him, she said, she might not be here today.

Following her testimony, the judge dismissed the jury for the day, however, a hearing will be held Saturday afternoon outside the presence of the jury to discuss pending motions and the jury instructions.