McALLEN — Jurors will begin deliberations Tuesday morning in the case of Dr. Jorge Zamora Quezada, an Edinburg-based rheumatologist accused of healthcare fraud.
Jurors selected a foreperson Monday and decided to begin deliberations Tuesday, which came after more than a month of testimony and after the attorneys delivered their closing statements Monday afternoon.
Zamora Quezada is alleged to have participated in a scheme to defraud health insurers by misdiagnosing and over-treating patients.
Meisy Zamora, his wife, and two of their former employees — Estella Santos Natera and Felix Ramos — were 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.
Ramos, represented by attorney Jaime Peña, was dropped from the case Monday morning after U.S. District Judge Ricardo H. Hinojosa found the government did not present enough evidence during the trial to support the charge of conspiracy to commit money laundering against all four defendants, the only count in the indictment Ramos was charged with.
During the government’s closing statement — delivered by attorney Rebecca Ruth Yuan — they argued that defendants Zamora Quezada, Zamora, and Natera cared more about making money than about caring for patients.
To them, “the patients were just numbers, just dollar signs,” Yuan said before proceeding to outline a five-part scheme allegedly perpetrated by the defendants:
>> Capture vulnerable patients
>> Falsely diagnose patients
>> Provide unnecessary services
>> Falsify patient records
>> Lie to health care benefit programs to get paid
Yuan reviewed the cases of several patients who were treated and diagnosed by Zamora Quezada with rheumatoid arthritis but were later told by a different rheumatologist that they didn’t have rheumatoid arthritis.
She noted that, looking just at Medicare beneficiaries, other rheumatologists disagreed with Zamora Quezada’s diagnosis of rheumatoid arthritis 79% of the time.
She also reminded the jury of testimony from former employees who testified about quotas for the number of patient visits they were expected to schedule every day.
Yuan said Meisy Zamora sent out the quotas to the employees and enforced them.
Meanwhile, Natera carried out their orders by making sure claims were submitted to insurers, Yuan said.
There was also an employee, Jose Tomas Moreno, who testified that when the clinic was asked to turn over patient records, he and a medical assistant replaced missing ultrasound images with those that belonged to different patients with the approval of Zamora Quezada.
Yuan pointed out that another employee, Raymundo Moreno, testified that he was asked to create patient notes and would write notes for patient visits that had occurred years prior.
During the defense’s closing, Stephen Lee — one of the attorneys for Zamora Quezada — said the government failed to prove without a reasonable doubt that the doctor intentionally made false diagnoses of rheumatoid arthritis, that he intentionally ordered unnecessary tests to make money, or that he intentionally directed the creation of false records to be provided to the grand jury.
Lee emphasized the idea of “pieces of a puzzle” that formed the basis for Zamora Quezada’s diagnoses of rheumatoid arthritis which, he said, the government wanted the jury to ignore.
He noted that there were patient questionnaires where patients recorded, in their own words, what symptoms they were experiencing and that medical assistants who were in the exam rooms were the ones who filled out some of the records.
If those records were wrong, Lee said, the patient would have said something.
Lee also attacked the credibility of employees who testified for the government, saying they came with baggage and bias.
Regarding Jose Tomas Moreno, in particular, Lee said he was the only one who spoke about falsified patient records and argued that Moreno did so to protect himself. He also argued there was no evidence that any of those falsified images were provided to the grand jury.
Turning to allegations by some employees that they 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, Lee reminded the jury of claims data reviewed during the trial that showed that not all patients were ordered the same procedures.
Regarding quotas, Lee said they were about productivity and that there was nothing wrong with the doctor wanting the staff to schedule the procedures that he had ordered.
During his closing, Christopher Sully, the attorney for Meisy Zamora, reminded the jury that she was arrested when she arrived at the federal courthouse to attend a hearing for her husband, who had already been arrested in this case. She came here, Sully said, because she knew she was innocent.
He also argued that the government did not provide any evidence to support the testimony from the former, “disgruntled,” employees whom the government “cherry-picked” to testify against her.
Adolfo “Al” Alvarez, the attorney for Natera, said the jury hardly heard anything about Natera during the course of the trial.
The government alleges that Natera, when interviewed by government agents, lied about the average number of claims the clinic filed on a daily basis.
However, Alvarez, noted that upon her arrest and interview, federal agents showed up with rifles and said they intimidated her to the point of tears.
Natera, Alvarez said, was likely confused, afraid, or simply couldn’t really remember.
With regard to the conspiracy of healthcare fraud, Alvarez said Natera didn’t have the experience or knowhow to participate in that.
Trey Martinez, the other attorney for Zamora Quezada, wrapped up closing statements for the defense by quickly going over the cases of the patients who were diagnosed by the doctor with rheumatoid arthritis but were later told by another rheumatologist they did not have the disorder.
Martinez, however, noted that those patients came in with many health issues and argued that Zamora Quezada had reason to believe they had rheumatoid arthritis.
But the government shot back in their rebuttal — delivered by attorney Jacob Foster — and reminded the jury that the rheumatologists who testified against Zamora Quezada said the cases weren’t a matter of a difference of opinion.
Following the closing statements, which lasted more than four hours, the judge delivered the jury instructions for their deliberations.
Zamora Quezada is charged with one count of conspiracy to commit healthcare fraud, eight counts of healthcare fraud, and a count of conspiracy to obstruct justice.
Meisy Zamora and Natera are charged with conspiracy to commit healthcare fraud. They were also initially charged with obstruction of justice but were dropped from that count after the judge determined the government did not present evidence during the trial that could possibly lead the jury to find them guilty of that charge.