Former staffer testifies about false records in healthcare fraud trial

When it came time to compiling patient files for an audit, employees of Dr. Jorge Zamora Quezada’s clinic replaced missing sonogram images with those of other patients, according to one of those employees who testified on Monday and Tuesday in the ongoing healthcare fraud trial.

The doctor, his wife Meisy Zamora and two of their employees — Estella Santos Natera and Felix Ramos — are currently on trial on allegations that they participated in an alleged scheme to defraud health insurers by misdiagnosing and over-treating patients. The federal indictment also alleges the scheme included tampering with medical records and money laundering to conceal the source of the funds they made from the alleged scheme.

Jose Tomas Moreno, formerly the supervisor of the medical assistants at the clinic, began working for the doctor at the Center for Arthritis and Osteoporosis in 2002 until he was terminated in May 2017.

He testified that during an audit by Medicare and Medicaid, they were asked to turn over patient records but because of a previous crash of their electronic records system, they were unable to locate ultrasound images that belonged in their reports.

When he informed the doctor the images couldn’t be found, Moreno testified that the doctor told him to create them. It was then that Moreno and another medical assistant began getting images of other patients and changing the names to those of patients whose ultrasound images were missing. He estimated they did that for about 40 to 50 patient files.

Around February or March 2017, Moreno said that he and the other medical assistant told the doctor they didn’t feel comfortable anymore replacing those images so the doctor told them to instead enter “no image found,” in the file.

Later on, after the FBI came to their offices, he said he was told to take time off. Then when he went to the office to pick up a paycheck, he was told he was fired though he was not given a reason for his termination, Moreno said.

However, when he tried applying for unemployment, he was denied because of allegations that he sexually harassed or harassed other employees at the clinic. Allegations, he said, he been previously unaware of.

When questioned by the defense, Moreno said that though they had replaced those missing ultrasound images, no other records were fabricated.

He also acknowledged that those ultrasound images did not serve a diagnostic purpose and in creating those images, they were not trying to make it appear as if some patients had rheumatoid arthritis — or any other condition — which they did not.

Moreno explained that although certain patients were missing the ultrasound images in their reports, the ultrasounds themselves had already been conducted for those patients, the images just couldn’t be found.

When the defense pointed to a statement Moreno had previously made to the FBI in which he denied witnessing any fraudulent activity at the clinic, Moreno admitted that he had lied out of fear and loyalty to the doctor.

With regard to the request for records through a grand jury subpoena — and the charge by the government that three of the four defendants in the trial obstructed justice by tampering with the records in response to the subpoena — Moreno acknowledged that he doesn’t know what went into those files.

On Monday, Moreno had testified that the clinic had daily quotas for how many patients were expected to be seen by each department at the clinic.

He said the doctor wanted to have a steady flow of patients and wanted to have at least 30 patients per day and wanted his physician assistant to do the same.

Those quotas were discussed during meetings with the department supervisors which Moreno said were sometimes held on a weekly basis but sometimes were biweekly or even just once a month.

The meetings were either led by Zamora Quezada or his wife Meisy Zamora, whom the staff referred to as “Doctora Meisy.”

In order to meet those quotas, Moreno said the front office would call the patients and schedule them to ensure the quotas were met.

They would print out the schedules to see how many patients were scheduled and each department had to turn in a daily count.

If the numbers were low, Moreno said Zamora Quezada would sometimes get upset. Meisy Zamora, however, would try to motivate the staff in positive way, Moreno said, telling the staff to work as a family and see the patients as family.

Following his testimony on Tuesday, the prosecution called one of Zamora Quezada’s former patients to testify about her experience with the doctor. Though he had diagnosed her with rheumatoid arthritis and fibromyalgia, a doctor she went to for a second opinion told her she did not have those conditions.

The defense for Zamora Quezada was in midst of their cross examination when the court broke for the day Tuesday afternoon.