SAN ANTONIO – Attorneys for a doctor with offices in San Antonio and the Rio Grande Valley are making a new challenge to the federal health care fraud charges against him, arguing the "entire case is based upon hearsay and misunderstanding of the medical practice."
Since his arrest in May, Dr. Jorge Zamora-Quezada has been held without bond on a 20-page indictment alleging federal health care fraud, health care fraud and conspiracy to commit money laundering. Prosecutors have said Medicare was among the agencies overbilled $240 million in the scheme that they claim lasted nearly two decades.
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Last month, Zamora-Quezada's wife, Meisy Zamora, was indicted on a charge of conspiracy to commit health care fraud. An arrest complaint said she insisted employees of her husband's medical office call her "Doctora Meisy" (however, it is not clear if she is a licensed physician). The document quotes six unnamed employees who said Zamora supervised employees in an office where "medical practices were driven by revenue targets, not patient care."
One employee said there were "quotas for different procedures: infusions, injections, x-rays, MRI, lab testing, and ultrasounds, and (Zamora) would get angry if the staff did not meet this quotas because the medical practices needed the revenue to meet payroll."
Other employees told investigators office billers would have diagnoses codes to make sure claims submitted to insurers would not be denied. Some told investigators Zamora participated in the "alterations and manufacture of medical records in response to investigations by law enforcement agencies."
The complaint said after grand jury subpoenas were served on Zamora-Quezada's office in March 2017, one employee said Zamora "was involved in the process of creating false and fictitious records. Specifically, Meisy Zamora worked with the laboratory technician to create missing laboratory results."
The employee "believed the results were being falsified."
Zamora's attorney said one employee had been fired, then "duped the FBI with a yarn about how he believed that other employees (not him) were falsifying records and that he brought that concern to the Zamoras, received no response from them, and was subsequently fired by Dr. Zamora."
The detention without bond of the couple has left "their fourteen-year-old daughter separated from her parents," one reason Zamora-Quezada's attorney urged a judge to reconsider holding him without bond.
A document filed this week cited a 2014 review by the Centers for Medicare & Medicaid Services that one overpayment to Zamora-Quezada was for services that were "medically necessary."
"After an independent medical examiner reviewed the file, which the Government has not done in this case, CMS determined that the services were medically necessary, and any services found to be not medically necessary were of no fault of Dr. Zamora-Quezada. The 'investigation' was cited by the Government in support of their search and seizures, however, absent from the affidavits was the fact that the decision was fully favorable to Dr. Zamora-Quezada," the document said.
Zamora-Quezada is specifically accused of falsely diagnosing patients with rheumatoid arthritis and treating them with chemotherapy drugs, a scheme prosecutors claim led to $240 million in claims, with the doctor receiving $50 million in payments since 2000.
"The Government’s entire case is based upon hearsay and misunderstanding of the medical practice," Zamora-Quezada's attorneys said.
The couple is asking a federal judge to allow them to be on bond until their case goes to trial. A judge is expected to take up Zamora-Quezada's request next week.