How one physician’s egregious acts tarnish the profession

There is fraud, and then there is fraud. Sometimes, I write about a situation involving a single physician and “upcoding.” While that certainly constitutes the submission of false claims for payment under government programs such as Medicare and Medicaid, at times, the amount in controversy is under $10 million.

A recent announcement from the U.S. Department of Justice takes allegedly fraudulent acts by Jorge Zamora-Quezada, MD, and his co-conspirators to a new level: $240 million in healthcare fraud and international money laundering.

This month, in the Southern District of Texas, Zamora-Quezada was charged in an indictment with the following: conspiracy to commit healthcare fraud; healthcare fraud; and conspiracy to commit money laundering. The physician’s acts were particularly egregious, according to the DOJ, because he, “allegedly orchestrated a massive fraud scheme that jeopardized the health and well-being of innocent children, elderly, and disabled victims… The allegations that Zamora-Quezada violated his oath to do no harm by administering unnecessary chemotherapy and other toxic medications to patients with serious diseases-including some of the most vulnerable victims imaginable-are almost beyond comprehension.”

In medicine, the Hippocratic Oath, which states that a physician is first and foremost to do no harm to a patient, serves as the basic tenant of patient care. Patients have a decisional right to autonomy, as well as a decisional right to provide informed consent and refuse treatment in most circumstances. Patients also have the non-decisional rights to be treated with respect and to treat them using benevolence, while avoid malfeasance.

Here, Zamora-Quezada exploited patients in a manner that some may equate to disclosing sensitive protected health information about STDs, mental health, or substance abuse treatment to those who are not permitted to have knowledge because of the devastating emotional and physical harm that is suffered. In this instance, the fraud extended to acts of battery because there was no informed consent provided by the patients. Some examples that were provided included diagnosing children and the elderly with various degenerative and auto-immune disease; and, in turn, administering toxic treatments such as chemotherapy, which was based on a false diagnosis.

Patients have a fundamental right to bodily integrity. And, whether a patient is sexually assaulted during a visit or provided a false diagnosis and treatment, the patient’s fundamental rights are violated. Zamora-Quezada and his co-conspirators completely disregarded every ethical facet of medicine, submitted fraudulent claims, and used the proceeds to fund a very lavish lifestyle in multiple countries.

In sum, physicians should be reminded of their basic obligations. While most physicians act in an ethical manner, cases like this one serve as a blemish on the profession of medicine.