Judge orders production of billing records in sentencing of doctor convicted of healthcare fraud

McALLEN — The defense team for Dr. Jorge Zamora Quezada, who was convicted of healthcare fraud in 2020, achieved a major development towards his sentencing.

During a hearing Tuesday, U.S. District Judge Ricardo H. Hinojosa granted a request by Zamora Quezada's attorneys to compel government prosecutors to turn over medical billing records.

The defense wants those records to dispute the prosecutors' claim about how many of former patients Zamora Quezada misdiagnosed with rheumatoid arthritis.

The number of patients will ultimately factor into the length of his sentence.

In arguing for the records, defense attorneys Stephen Lee and Trey Martinez said the government was claiming, without evidence to back it up, that Zamora Quezada had misdiagnosed 13,000 patients.

They noted that during the trial, which spanned nearly 30 days throughout December 2019 and January 2020, the government presented evidence for only a handful of former patients.

Further, they pointed out that some of his former patients had even continued to receive treatment for rheumatoid arthritis from other rheumatologists, indicating that Zamora Quezada had not misdiagnosed them after all.

By alleging he had misdiagnosed 13,000 patients, the defense said that prosecutors were asking the judge to make an assumption.

An attorney for the government, Emily Gurskis, confirmed that the government is alleging Zamora Quezada misdiagnosed "thousands" of patients but could not provide an exact number.

She argued that fraud was so pervasive in this case to the point that, according to case law, the burden fell to the defense to prove which patients were legitimately diagnosed with rheumatoid arthritis.

However, Lee argued that case law did not apply in this scenario and insisted that if the government was not going to prove with billing records which patients were misdiagnosed, then they needed to turn over records for all 13,000 patients to the defense.

With those records, the defense hopes to determine which patients received treatment for rheumatoid arthritis from other rheumatologists. In identifying such patients, they'll likely argue that those individuals were not misdiagnosed.

The judge sided with the defense, ordering the government to turn over billing records from Medicare, Medicaid, and TRICARE — all government insurance programs — for the thousands of patients that were allegedly misdiagnosed.

For the allegedly misdiagnosed patients who were privately insured by Blue Cross Blue Shield of Texas, the judge signed a subpoena ordering the turnover of their billing records as well.

It's unclear how long it will take the government to turn over the requested records, however, the defense clarified they are seeking billing information going back more than 20 years.

Zamora Quezada had medical practices in Edinburg, San Antonio, and Brownsville before his arrest in 2018 on allegations he ran a scheme to defraud insurers by misdiagnosing and unnecessarily treating patients for rheumatoid arthritis.

In January 2020, a jury found him guilty of one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud, and one count of conspiracy to obstruct justice.