Jurors to Start Deliberations Tuesday in Valley Doctor’s Health Care Fraud Trial
UPDATE (7:50 PM): The jury chose a foreperson Monday afternoon and asked permission to start deliberations on Tuesday.
MCALLEN – The jury is now deliberating the fate of a Rio Grande Valley doctor, his wife and a billing supervisor accused of health care fraud.
Final arguments were offered in the case of rheumatologist Dr. Jorge Zamora-Quezada, his wife, Meisy Zamora, and a billing supervisor, Estella Natera. The doctor is facing a conspiracy to commit health care fraud, health care fraud and obstruction of justice. His wife and Natera are only facing the conspiracy to commit health care fraud charge after the indictment was tailored Monday morning.
“Profit was more important than the patients” emphasized government prosecutors as they opened their final argument. They went over the five-step scheme they believe was in place at the doctor’s office and orchestrated with the help of his wife and Natera.
The first step was capturing vulnerable patients. Government attorneys say the doctor was the only one who could meet with patients on their initial visit. It would position Dr. Zamora-Quezada to diagnose them and send them to receive diagnostic testing. That was proceeded by a misdiagnosis of rheumatoid arthritis, a life-long disease that would require multiple visits.
Prosecutors cited witness testimony from former doctors who worked with Dr. Zamora-Quezada. Those doctors said they examined patients diagnosed with rheumatoid arthritis by Zamora-Quezada, and frequently disagreed with the diagnosis, changed it and stopped treatment.
However, when Dr. Zamora-Quezada saw those changes, he would revert them to reflect his initial diagnosis. The misdiagnosis would allow for the referral of unnecessary services at their expanded clinic, which included various equipment owned by Zamora-Quezada.
Some witnesses described the medical office as a “Walmart of medicine” or an “assembly line for patients.” Those services would be billed to medical insurance programs.
When filing for those claims, the government states Zamora-Quezada’s office would falsify records. On one occasion, when a medical insurance company denied a claim as medically unnecessary, a blood test result was changed from negative to positive.
The final step in the scheme was lying to medical insurance programs – Medicare, Medicaid, TriCare and Blue Cross Blue Shield – to get paid.
Defense attorneys reminded jurors of the government’s burden to prove the crimes were committed intentionally and without a reasonable doubt.
Attorneys defending Dr. Zamora-Quezada reminded jurors of their concern with the analysis presented to them by an expert hired by the government. A statistician took the stand who spoke about their analysis of medical claims and billing data.
Defense attorneys are questioning the data used after the expert said they used data for patients who only received a diagnostic test as they did from patients diagnosed with rheumatoid arthritis.
When asked about the methodology employed to examine the data, the expert admitted there was confusion regarding dates of service and submission dates. Defense attorneys contend the dates are important in establishing the data falls within the time period the government alleges the crime was occurring.
The testimony offered by government witnesses was described as “uncorroborated opinions of former employees,” by the legal team representing the defendants. They asked the jury to consider their employment history or their criminal histories, some of whom were terminated or who had quit.
“Quotas are not a sign of productivity, they’re a sign of fraud,” government attorneys told the jury as they reminded them of their accusation that Meisy Zamora enforced them and requested a daily log tracking billing information. Her attorney said these quotas are “common” and function as a productivity measure that help medical practices ensure patients receive tests doctors request for their patients.
Estella Natera’s attorney, Al Alvarez, went last in presenting his arguments. He explained the government is alleging the crime was committed to enrich those involved, but classified her as just a “working person” earning an annual salary of $35,000. Alvarez also questioned why Natera was indicted after being under surveillance for one day.
Government attorney told jurors Natera was complicit when she took the job. Witnesses said no claims were submitted without her approval. Government attorneys said she lied to FBI agents denying she submitted 100 claims a day, but other witnesses said they submitted on average of 95 to 105 daily claims.
Before finishing final arguments, defense attorney Trey Martinez encouraged jurors against a conviction, because it could discourage future rheumatologists from requesting tests for their patients. Prosecutors said this case is about greed and lies used to make more money by ordering unnecessary tests.
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