McALLEN — Two former employees of the Centers for Arthritis and Osteoporosis, the clinic owned by Dr. Jorge Zamora Quezada, testified Thursday about what they perceived to be unusual practices at the clinic as part of the ongoing trial.
Zamora Quezada, a rheumatologist is currently on trial for allegations that he participated in a scheme to defraud health insurers by misdiagnosing and over-treating patients.
Co-defendants in the case are his wife, Meisy Zamora, and two of their employees, Estella Santos Natera and Felix Ramos. They are 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.
The two witnesses for the U.S. government were questioned on direct examination by Adrienne Ellen Frazior and Rebecca Ruth Yuan, two attorneys representing the government.
The first witness to testify Thursday was Emilia Duhleru, a rheumatologist originally from Romania who worked at the clinic for three years, from 2003 to 2006.
After departing the clinic she practiced rheumatology in Missouri but then returned to the Rio Grande Valley in 2010 and has remained here since then.
Duhleru said she first took the job at Zamora Quezada’s clinic because she was looking for a job at an undeserved area in order to qualify for a Visa waiver, allowing her to stay in the country after she completed her training in New York.
In order to qualify for the wavier, she had to stay at the clinic for three years, though she said tried to leave earlier because she was uncomfortable with the Zamora Quezada’s practices.
Among them was the volume of patients she would see, which would be about 25 patients per day, at most 30, she said.
Zamora Quezada would see the patients on their first visit, Duhleru said, while she would mostly see patients on their follow-ups.
On several of those occasions, she said she was concerned about how frequently rheumatoid arthritis was diagnosed but also in seeing multiple diagnoses which she said normally are not found in one, single patient.
When she would disagree with Zamora Quezada’s diagnoses, Duhleru said she would change it and cautiously taper down the patient’s medication.
However, sometimes if Zamora Quezada would follow up with the patients, he would change the diagnosis back and restart treatment.
She also noted that his visits with patients would last about five to 10 minutes.
In her own practice, which she later opened in Edinburg in 2011, she said she saw no more than 22 patients per day and her visits with new patients would take about 30 to 45 minutes while follow up visits would take about 15 to 20 minutes.
During her time at Zamora Quezada’s clinic, she said he confronted her about not ordering enough tests.
She said the doctor was upset that she hadn’t ordered a test for a patient with carpal tunnel. She told him she didn’t order the test because she believed that it was a something that a primary care physician should order and didn’t think it was medically necessary.
Duhleru testified that Zamora Quezada was angry and told her that she didn’t know anything.
She also said she was concerned with the number of X-rays that were ordered, believing that some were not medically necessary and was also concerned with their interpretation.
She said X-rays that appeared normal to her were noted as being abnormal and that the X-ray reports were very similar from one patient to another, describing them as “cookie cutter.”
She expressed similar concerns about the MRIs that were ordered and said she didn’t feel like she could trust them.
At one point, she said she confronted Zamora Quezada about the labs and asked him to justify a test for vasculitis when she believed the patient didn’t show signs of it and questioned whether the insurance would even pay for it.
Duhleru said that the doctor sort of dismissed the issue and said the insurance would pay.
Another concern had to do with the superbills which are forms that note down what procedures had been ordered for a patient during a particular visit that also includes their diagnosis.
She said that she would fill out the super bills at the end of the visit but noticed that some were changed to add tests that she hadn’t ordered. However, she doesn’t know who changed them.
In 2015, when she had her own private practice, she treated one of Zamora Quezada’s former patients whom he had diagnosed with rheumatoid arthritis.
Though the patient had a family history of rheumatoid arthritis, Duhleru said that in her three years treating that patient, she never diagnosed her with the disease.
Upon cross-examination by Zamora Quezada’s defense attorney, Stephen Lee, she acknowledged she hadn’t worked at the clinic for 13 years and had no personal knowledge of the situation there since then.
Lee also brought up a complaint she had made in 2006, her only written complaint, in which she raised concerns about the mid-level practitioners. Lee noted that she didn’t mention anything about false diagnoses or concerns about the number of tests that were ordered.
Regarding the conversation with the doctor over a patient who had carpel tunnel for whom she had not ordered a test, Lee noted her concern was that she thought the test should have been ordered by primary care physician but not that the test should not have been done at all.
Turning to the length of time Zamora Quezada spent with patients, Lee posited that it was the complexity of the visit and not the time spent with patients that mattered, to which she agreed.
The second witness on Thursday was Aidee Dejesus who formerly worked as the billing supervisor at the clinic.
Dejesus said she worked there for five years, beginning in 2010, and during her time there was also a patient.
Her family, including her sister, aunt, and grandmother had rheumatoid arthritis
At the time, she didn’t have insurance so she couldn’t afford to see another doctor. Zamora Quezada, however, treated her free of charge.
When she began working at current job with Doctors Hospital at Renaissance, she was able to get health insurance and went to another doctor.
That doctor, a doctor of internal medicine, did not diagnose her with rheumatoid arthritis and she did not continue to take medication for it.
When she started working at the clinic in 2010, she began working there part-time in data entry. However, she was later hired full time to handle the large backlog.
Dejesus testified about encounters she had with Zamora Quezada over the intake volume and said each department had quotas for how many people needed to be seen.
When questioned by the defense, she said there wasn’t necessarily anything wrong with scheduling a lot of patients for one day, seeing as how there was a long wait list of people needing to see the doctor.
She did note, however, that number of complaints the billing department received were higher than at any other clinic she had worked.
One patient complaint led to her quitting her job at the clinic.
The patient complained about a medication they had been billed for but hadn’t received. The medication, it turned out, had been sent to the clinic because that’s where it was supposed to be administered.
However, Dejesus testified she had been told it had been administered to another patient.
The following day she was reprimanded for it and was told she would be suspended for three days. However, she opted to quit.
Dejesus was the final witness to testify on Thursday.
The trial is scheduled to resume on Monday.