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Prosecution Rests in Federal Trial of Valley Doctor Accused of Health Care Fraud

6 months 1 week 20 hours ago Monday, January 06 2020 Jan 6, 2020 January 06, 2020 5:44 AM January 06, 2020 in News - Local

MCALLEN – Government prosecutors rested their case, a month after the trial began for Dr. Jorge Zamora-Quezada, his wife and two other defendants accused of misdiagnosing patients in their Rio Grande Valley clinic to collect millions from the government.

U.S. attorneys called their last witness Monday, Mike Petron, a statistician and managing director at Stout, a D.C. firm hired by the government to analyze medical and billing data.

Petron testified about an analysis which used data from patients who attended the doctor’s office for a set amount of time as outlined by the federal indictment. The analysis found of all those patients, 72.9% received a positive diagnosis for rheumatoid arthritis. Statisticians also received and processed data collected for at least five other doctors. They found that the average rate of positive diagnosis was 13.8%, a 59.1% difference with Dr. Zamora-Quezada’s office.

The analysis also looked at the patients from that time period who also went to a second rheumatoid arthritis doctor. They identified 772 patients. Of those, 74% of those patients received a negative diagnosis for rheumatoid arthritis compared with the positive diagnosis they received from Dr. Zamora-Quezada.

Data analysts also compared the amount billed and paid for the services provided the Medicare beneficiaries to Dr. Zamora Quezada and other rheumatologists. They found Dr. Zamora Quezada was getting paid at least five times more (a total of $26 million) than the doctor who came in second ($8 million).

During cross-examination, attorneys for the defense questioned the methodology of the analysis. They questioned what data they considered. Petron conceded some of the data included that of patients who were not treated for rheumatoid arthritis but only tested for it.

The defense also questioned whether the sample size used to compare data from Dr. Zamora-Quezada’s office against other rheumatologists was fair, but the witness said they were working with the data they were given.

The trial which started a month ago, Dec. 6, 2019, was expected to last three weeks. Witnesses for the defense are expected to be called to the stand in the following days.

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