◆ Mission, Texas, rheumatologist Jorge Zamora-Quezada, M.D., was found guilty by a jury Jan. 15 for his part in a $325 million heath fraud scheme in which he “falsely diagnosed patients with life-long diseases and treated them with toxic medications,” the Department of Justice said.^[1] Zamora-Quezada gave many patients a fake diagnosis of rheumatoid arthritis and treated them with chemotherapy drugs and other medically unnecessary medications. As a result, the patients suffered physical and emotional harm. Some patients were as young as 13. Evidence presented at trial showed the physician also falsified medical records, the Department of Justice said. Zamora-Quezada was convicted of health fraud, conspiracy to commit health fraud and conspiracy to obstruct justice.

◆ A primary care physician in Webster City, Iowa, was sentenced to two months in prison in connection with his guilty plea for making false statements related to health care matters, the U.S. Attorney’s Office for the Northern District of Iowa said^[2] Jan. 16. Joseph X. Latella, who was the medical director for two nursing homes, also will pay $316,438 to settle False Claims Act^[3] allegations that he upcoded Medicare and Medicaid claims for routine visits to nursing home patients from Jan. 1, 2014, to Nov. 30, 2018. In July 2016, a Medicare contractor sent Latella a letter warning him “that his billing patterns were significantly more expensive than other doctors,” the U.S. attorney’s office said. Two years later, Latella submitted sworn letters to the U.S. attorney in which he falsely stated that he spent about 35 minutes each on the care of 12 patients at two nursing homes. “In truth, a federal agent had conducted in-person surveillance of Dr. Latella on that date, and Dr. Latella only was onsite at the first nursing home for a total of 47 minutes and did not visit the second nursing home at all on that date,” the U.S. attorney stated. In addition, the physician gave the U.S. attorney phony “re-created” treatment notes “to cover up his overbilling scheme.”

◆ CMS said Jan. 21 it has finalized a national coverage determination^[4] that covers acupuncture for patients with chronic low back pain. “CMS conducted evidence reviews and examined the coverage policies of private payers to inform today’s decision,” the agency said.