Latest news with #healthcarefraud
CBS News
03-06-2025
- Business
- CBS News
2 West Covina women arrested for alleged $4.8 million hospice care fraud
The U.S. Department of Justice announced that two West Covina women were arrested Tuesday for an alleged scheme to defraud Medicare of $4.8 million with false hospice care claims. One of the women who was arrested is the owner and operator of two West Covina hospices, Golden Meadows Hospice Inc., and D'Alexandria Hospice Inc., which billed Medicare for hospice services for patients who were allegedly not terminally ill. Between Sept. 2018 and Oct. 2022, owner and operator Normita Sierra, 71, and an accomplice, Rowena Elegado, 55, collected more than $3.8 million from Medicare on false claims, the DOJ said. Sierra, of West Covina, is charged with nine counts of healthcare fraud, one count of conspiracy, and four counts of illegal remuneration for healthcare referrals. Elegado, also of West Covina, is charged with one count of conspiracy, and four counts of illegal remuneration for health care referrals. Sierra and Elegado allegedly worked together to pay marketers to recruit patients to the hospices, knowing that most of those patients had not been referred by their primary care physicians for such services. According to the DOJ, once enrolled, the fraudulent patients rarely died in hospice care and were often discharged after six months, with payouts reaching as much as $1,300 per patient each month they stayed in hospice service. Others involved in the alleged scheme include Carl Bernardo, 53, of Chino, who pleaded guilty in September 2024 to one count of receiving kickbacks in connection with a federal health care program, and Relyndo Salcedo, 60, of Fontana, a nurse practitioner who pleaded guilty on May 22 to one count of health care fraud. According to the DOJ, Salcedo was pressured to admit ineligible patients into the hospice and then exaggerated and falsified the patients' conditions to make them seem terminally ill. If convicted of the charges, Sierra would face a maximum sentence of 10 years in federal prison for each count of healthcare fraud. Sierra and Elegado would face up to five years in federal prison for the conspiracy count and up to 10 years in federal prison for each illegal kickback count. The United States Department of Health and Human Services Office of the Inspector General and the FBI investigated the matter.
Daily Telegraph
25-05-2025
- Health
- Daily Telegraph
Doctor who falsely diagnosed healthy patients to fund lavish lifestyle sentenced to 10 years prison
Don't miss out on the headlines from Health. Followed categories will be added to My News. A Texas doctor who falsely diagnosed his healthy patients to fund his lavish lifestyle with private jets and luxury sports cars as part of a US$118 million (A$182m) health care scheme was sentenced to a decade behind bars. Rheumatologist Jorge Zamora-Quezada defrauded patients and insurance companies by purposefully diagnosing people with rheumatoid arthritis despite them not having the lifelong and incurable condition, The NY Post reports. Zamora-Quezada, 68, masterminded the scheme out of his Mission, Texas office with the help of staffers who were abused and threatened by his status, the Department of Justice said. The disgraced health care provider led patients to believe they were suffering from chronic illnesses and they would pay unnecessary and costly treatments and testing that included a variety of injections, infusions, X-rays, MRIs, and other procedures. The regimens included the administration of toxic medications that had potentially harmful and even deadly side effects. Jorge Zamora-Quezada was sentenced to 10 years in prison for defrauding patients and insurance firms out of millions of dollars. Picture: FBI Zamora-Quezada also falsified medical records of his patients to secure insurance funds from providers by falsifying medical. He defrauded US$28 million (A$43m) from Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield. Other doctors in the Rio Grande Valley testified against Zamora-Quezada during the 25-day trial, revealing the surprising findings when they treated hundreds of patients, believing they had RA. 'For most (patients) it was obvious that they did not have rheumatoid arthritis,' one rheumatologist testified. The dangerous treatments Zamora-Quezada prescribed caused patients to develop debilitating side effects, including strokes, necrosis of the jawbone, hair loss and liver damage. Other victims developed pain so severe that they were left unable to perform simple, everyday tasks. 'Constantly being in bed and being unable to get up from bed alone, and being pumped with medication, I didn't feel like my life had any meaning,' one patient told the court. According to a courtroom report from nearly 20 victims offered statements, including Miranda Hinojosa, who was transported by ambulance. She told the court she is now bedridden due to the unnecessary chemotherapy provided by Zamora-Quezada starting when she was 11 years old. 'I hope you rot in hell!' another victim said. A mother compared her child to a lab rat with the amount of medication Zamora-Quezada prescribed. The corrupt caregiver used his position to hire foreign staffers who needed employment to remain in the country on their J-1 visas and wouldn't question his authority unless they risked being fired and deported. The two-engine, six-passenger jet Zamora-Quezada purchased with the money he got through his scheme. Picture: DOJ One of Zamora-Quezada's real estate properties that he was ordered to forfeit after his conviction. Picture: DOJ Calling himself 'eminencia' — or eminence, Zamora-Quezada built a work atmosphere of fear and authority. Zamora-Quezada would use his employees as models for ultrasounds that he would include as part of a fabricated missing patients file if he were audited by an insurer. Thousands of patient files were stored in a separate shed ravaged by rodents and termites — most documents covered in faeces and urine. If he was questioned on missing patients' records, the doctor would order his staffers to make files 'appear.' The records storage of Zamora-Quezada's office after his arrest. Picture: DOJ Zamora-Quezada used the millions in takings to build an expansive real estate portfolio complete with 13 separate properties in the US and Mexico, purchased a two-engine plane and a Maserati GranTurismo. 'Dr Zamora-Quezada funded his luxurious lifestyle for two decades by traumatising his patients, abusing his employees, lying to insurers, and stealing taxpayer money,' the DOJ's Criminal Division head Matthew R. Galeotti said. 'His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctors.' Zamora-Quezada was convicted of one count of conspiracy to commit health care fraud, seven counts of health care fraud, and one count of conspiracy to obstruct justice. He was sentenced to 10 years in prison and ordered to forfeit $28,245,454, his real estate portfolio, jet and Maserati. 'Today's sentence is not just a punishment — it's a warning. Medical professionals who harm Americans for personal enrichment will be aggressively pursued and held accountable to protect our citizens and the public fisc,' Galeotti said. This article originally appeared in The NY Post and was reproduced with permission. Originally published as Doctor who falsely diagnosed healthy patients to fund lavish lifestyle sentenced to prison
News.com.au
25-05-2025
- Health
- News.com.au
Doctor who falsely diagnosed healthy patients to fund lavish lifestyle sentenced to prison
A Texas doctor who falsely diagnosed his healthy patients to fund his lavish lifestyle with private jets and luxury sports cars as part of a US$118 million (A$182m) health care scheme was sentenced to a decade behind bars. Rheumatologist Jorge Zamora-Quezada defrauded patients and insurance companies by purposefully diagnosing people with rheumatoid arthritis despite them not having the lifelong and incurable condition, The NY Post reports. Zamora-Quezada, 68, masterminded the scheme out of his Mission, Texas office with the help of staffers who were abused and threatened by his status, the Department of Justice said. The disgraced health care provider led patients to believe they were suffering from chronic illnesses and they would pay unnecessary and costly treatments and testing that included a variety of injections, infusions, X-rays, MRIs, and other procedures. The regimens included the administration of toxic medications that had potentially harmful and even deadly side effects. Zamora-Quezada also falsified medical records of his patients to secure insurance funds from providers by falsifying medical. He defrauded US$28 million (A$43m) from Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield. Other doctors in the Rio Grande Valley testified against Zamora-Quezada during the 25-day trial, revealing the surprising findings when they treated hundreds of patients, believing they had RA. 'For most (patients) it was obvious that they did not have rheumatoid arthritis,' one rheumatologist testified. The dangerous treatments Zamora-Quezada prescribed caused patients to develop debilitating side effects, including strokes, necrosis of the jawbone, hair loss and liver damage. Other victims developed pain so severe that they were left unable to perform simple, everyday tasks. 'Constantly being in bed and being unable to get up from bed alone, and being pumped with medication, I didn't feel like my life had any meaning,' one patient told the court. According to a courtroom report from nearly 20 victims offered statements, including Miranda Hinojosa, who was transported by ambulance. She told the court she is now bedridden due to the unnecessary chemotherapy provided by Zamora-Quezada starting when she was 11 years old. 'I hope you rot in hell!' another victim said. A mother compared her child to a lab rat with the amount of medication Zamora-Quezada prescribed. The corrupt caregiver used his position to hire foreign staffers who needed employment to remain in the country on their J-1 visas and wouldn't question his authority unless they risked being fired and deported. Calling himself 'eminencia' — or eminence, Zamora-Quezada built a work atmosphere of fear and authority. Zamora-Quezada would use his employees as models for ultrasounds that he would include as part of a fabricated missing patients file if he were audited by an insurer. Thousands of patient files were stored in a separate shed ravaged by rodents and termites — most documents covered in faeces and urine. If he was questioned on missing patients' records, the doctor would order his staffers to make files 'appear.' Zamora-Quezada used the millions in takings to build an expansive real estate portfolio complete with 13 separate properties in the US and Mexico, purchased a two-engine plane and a Maserati GranTurismo. 'Dr Zamora-Quezada funded his luxurious lifestyle for two decades by traumatising his patients, abusing his employees, lying to insurers, and stealing taxpayer money,' the DOJ's Criminal Division head Matthew R. Galeotti said. 'His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctors.' Zamora-Quezada was convicted of one count of conspiracy to commit health care fraud, seven counts of health care fraud, and one count of conspiracy to obstruct justice. He was sentenced to 10 years in prison and ordered to forfeit $28,245,454, his real estate portfolio, jet and Maserati. 'Today's sentence is not just a punishment — it's a warning. Medical professionals who harm Americans for personal enrichment will be aggressively pursued and held accountable to protect our citizens and the public fisc,' Galeotti said.
Yahoo
24-05-2025
- Business
- Yahoo
Man facing massive restitution payment for $30M scheme targeting Medicare patients
A businessman who perpetrated a nearly $30 million health care fraud could be forced to pay back more than $15 million in restitution after agreeing to plead guilty to federal charges this week. Raju Sharma, 61, of Sharon, owned a medical device company that targeted Medicare beneficiaries by billing the federal health care program for devices the patients often did not need, according to federal prosecutors. The company billed Medicare more than $29 million for fraudulent medical device orders between 2021 and 2025, roughly $15.8 million of which was paid out. With the 'substantial profits' he earned from the scheme, Sharma purchased two Ferraris, a Mercedes-Benz, at least three Rolex watches and other high-end goods, prosecutors said. Sharma agreed to forfeit the luxury items and over $250,000 in cash federal investigators seized from his bank accounts, according to the U.S. Attorney's Office for Massachusetts. The office will also recommend that he be sentenced to 10 years in prison and ordered to pay more than $15.8 million in restitution. A sentencing hearing has not yet been scheduled. Sharma was arrested in February and released pending trial. He was detained again last month after authorities said he violated the conditions of his release by contacting at least one potential witness in the case. Sharma, acting on behalf of his companies Pharmagears and RR Medco, worked with telemarketing companies to generate medical device orders for Medicare beneficiaries, prosecutors said. He is accused of billing Medicare for medically unnecessary devices, which the patients often did not want or could not use. Some devices were ordered without a medical practitioner examining the patient, while others were ordered without providers' knowledge. Though Sharma agreed in contracts to pay the market companies a flat fee, he instead paid them on a per-lead or per-order basis, in violation of anti-kickback laws, prosecutors said. He claimed to be a police officer selling repossessed cars. The scam cost buyers $1,000s Justice Dept. official ID's next step in Springfield police reform, amid uncertainty over its status Feeding Hills woman to plead guilty in commercial mortgage scheme 'Strange and dangerous precedent': Tufts student's lawyer argues to keep case in Mass. Read the original article on MassLive.
Fox News
21-05-2025
- Health
- Fox News
Texas doctor sentenced to 10 years in prison in one of the ‘most significant' cases of patient harm
A Texas-based doctor was sentenced Wednesday to 10 years in prison for healthcare fraud after he carried out what prosecutors said was a nearly two-decade scheme that involved falsely diagnosing thousands of patients with degenerative diseases and profiting handsomely off their treatments. Jorge Zamora-Quezada, a rheumatologist licensed to practice medicine in Texas, Arizona and Massachusetts before being stripped of his licenses in each state, raked in hundreds of millions of dollars for the misdiagnoses and treatment he ordered during his roughly 20 years as a medical practitioner. The treatments included punishing rounds of chemotherapy, intravenous infusions, and a battery of other tests, monthly visits, and regular procedures associated with the treatment of rheumatoid arthritis, a chronic, autoimmune condition for which there is no cure. The sentencing, and his earlier court appearances, played out at times like a study in contrasts. Prosecutors detailed his extravagant lifestyle, including a private jet, 13 properties across the U.S., including in Aspen and various towns in Mexico, and a Maserati – while the health of the patients he defrauded continued to worsen. Prosecutors accused him of taking advantage of vulnerable individuals in Texas, such as teenagers, elderly individuals, and disabled persons, in order to carry out the scheme. Some of them testified at Wednesday's hearing about the ongoing side effects they suffered as a result of the doctor's actions, including receiving chemotherapy or IV infusions they did not need. It's "one of the most egregious" cases of its kind the Justice Department has brought in this space, Matthew Galeotti, head of the Justice Department Criminal Division, told Fox News Digital in a sit-down interview on Wednesday. That's because of "all of the various kinds of misconduct rolled into one," he said, "and because it was pervasive – the scheme lasted more than 18 years." "By the time you're towards the end of the scheme, he knows the consequences some of these things have had on the victims, and he's going forward anyways," he said of the doctor. The Justice Department's Criminal Division has been prosecuting this case for years. Unlike other departments, it is one of the few where career and political staff alike are largely in lockstep, with goals and cases that transcend partisan politics and seek instead to hold criminals like the Texas doctor accountable. Galeotti said he sees the case as emblematic of the Trump administration's goals to vindicate victims and counter wasteful government spending. "Even in cases where you don't see this level of misconduct, where you're not prescribing someone chemotherapy medicine that doesn't need it, which obviously sort of stands out on its own, we still have a problem because you were wasting government funds that should be going to actually benefiting patients," Galeotti said. A separate Justice Department official told Fox News Digital Zamora-Quezada's case was one of the "most significant" instances of patient harm that he had seen in at least a decade. "There was testimony about truly debilitating side effects from the medications, things like strokes, necrosis of the jawbone, really the jawbone melting away, hair loss, liver damage," the official said. The doctor's actions were seen as particularly egregious, in the Justice Department's telling, because they sought to prey on lower-income communities in Texas, targeting teenagers, elderly persons, and disabled individuals. The doctor also operated in areas with less access to medical care and with fewer native English speakers compared to other parts of the state. "Of course, it's always the most twisted when you're benefiting from someone else's misfortune – misfortune you caused – and misfortune you used for your own personal enrichment," Galeotti said. "They're the hallmarks of the worst kind of conduct that you see," Galeotti said. Zamora-Quezada was convicted by a jury in 2020 of seven counts of healthcare fraud, one count of conspiracy to commit healthcare fraud, and one count of obstruction of justice. His attorneys argued that the fraud was not "pervasive" in the way the government made it out to be, according to public court filings. Prosecutors said Zamora-Quezada purchased condominium properties in vacation towns, including in Aspen, San Diego, and Puerto Vallarta, Mexico. They said he commuted to his various doctors' offices in Texas in a Maserati and a private jet, both emblazoned with his initials, "ZQ." His assets were forfeited after he was charged, prosecutors said. Meanwhile, they said, while Zamora-Quezada was living a life of luxury, out of nearly 100,000 Medicare patients he treated, Zamora-Quezada diagnosed 72.9% of them with rheumatoid arthritis. Prosecutors compared that data to seven other Texas rheumatologists, who cumulatively diagnosed 13% of their patients with the same condition. Prosecutors asked for $100 million in restitution, but the judge required him to pay $28 million. Attorneys for Zamora-Quezada did not respond to Fox News Digital's request for comment.
