Government rests in healthcare fraud trial


McALLEN — The government rested its case against Dr. Jorge Zamora Quezada on Monday afternoon after a month of testimony.

The prosecutors closed out their case with Michael Petron, a CPA and managing director of a DC-based investment banking and management consulting firm. Petron testified Monday about his analysis of bank accounts and the clinic’s billing data.

Zamora Quezada, a rheumatologist, is on trial for allegations that he participated in a scheme to defraud health insurers by misdiagnosing and over-treating patients.

Co-defendants in the case are 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.

Petron described how the funds that Zamora Quezada’s clinic received from insurers flowed through the clinic and then from one bank account to another. The funds were then used, at least in part, for personal expenses.

Reviewing their bank accounts, Petron determined that part of the money used for car loan payments, credit card payments and travel related expenses could be traced back to insurance proceeds.

For the purchase of a Maserati, for example, over $91,000 in loan payments were made to finance the vehicle. Of that amount, $52,000 were traced back to insurance company proceeds.

Also traced back to insurance proceeds were about $6,000 of a total of $16,000 paid to the Ritz Carlton in Aspen, Colo.

Turning to the data of patients and the number of medical procedures ordered, Petron said that an average of 73% of patients seen by Zamora Quezada were diagnosed with rheumatoid arthritis, according to Medicare data.

That’s compared to an average of 13.8% among seven other doctors.

Data also showed that Zamora Quezada shared 772 patients with those other doctors, and that in 79% of those cases the doctors disagreed with Zamora Quezada’s diagnosis of rheumatoid arthritis.

However, the doctor’s defense attorney, Stephen Lee, questioned Petron’s methodology and noted that the data included patients who didn’t necessarily receive medical care for rheumatoid arthritis but were simply billed for tests to diagnose the disease.

On re-direct questioning by the government, though, Petron clarified that he was conservative with Zamora Quezada’s count of patients with rheumatoid arthritis. For Zamora Quezada, Petron only counted the patients who had a primary diagnosis code for the condition, unlike the other seven doctors, for whom he counted every single claim for procedures linked to rheumatoid arthritis. 

Lee also questioned whether Petron compared how often the other rheumatologists agreed or disagreed amongst themselves. Petron said he did, but to his recollection there was only one instance when two rheumatologists agreed with each other about 50% of the time. The other doctors appeared to agree with each other the majority of the time.

With the conclusion of Petron’s testimony, the government rested its case and the jury was released for the day.

The defense is scheduled to begin calling witnesses Tuesday morning.