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    Texas Doctor Who Filed $118 Million in Fraudulent Medical Claims Gets 10 Years in Prison

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    Jorge Zamora-Quezada falsely diagnosed patients with a chronic disease and subjected them to unnecessary treatments to help fund his lavish lifestyle, officials said.For nearly 20 years, a Texas doctor falsely diagnosed patients as having a chronic disease, administered unnecessary, toxic treatments and filed more than $118 million in fraudulent health insurance claims to fund his lavish lifestyle, which included a private jet, luxury cars and high-end properties, prosecutors said.The doctor, Jorge Zamora-Quezada, 68, of Mission, Texas, was sentenced to 10 years in prison this week, according to the Justice Department.From 2000 to 2018, he falsely diagnosed patients with rheumatoid arthritis and administered dangerous, medically unnecessary treatments to defraud federal and private health insurance companies, the Justice Department said.Rheumatoid arthritis is a chronic disease that causes a person’s immune system to attack healthy tissue. Some of Mr. Zamora-Quezada’s patients were as young as 13, the Justice Department said.Mr. Zamora-Quezada’s medical license was canceled in 2021, according to Texas Medical Board records.His scheme funded what prosecutors described in court documents as his “lavish and opulent lifestyle,” with properties across the United States and Mexico, as well as a private jet and a Maserati that he used to travel between his offices in the Rio Grande Valley and San Antonio.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump Squeezes His Party on Domestic Policy Bill

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      The president visited the weekly meeting of House Republicans to make the case for the legislation and pressure members of his party to fall into line.President Trump on Tuesday huddled with House Republicans on Capitol Hill to urge them to unify around a wide-ranging bill to deliver his domestic agenda, ratcheting up the pressure for the party to overcome divisions that could sink the package.Joining Republicans at their weekly closed-door meeting, Mr. Trump praised Speaker Mike Johnson, who has been toiling to cobble together the votes to pass what the party has dubbed the One Big Beautiful Bill Act, which they hope to bring to a vote by the end of the week.“I’m his biggest fan — I love this guy,” Mr. Trump said of Mr. Johnson before the meeting. The speaker can afford to lose no more than three votes on the bill if all Democrats oppose it, as expected, and every lawmaker is present and voting.The president made it clear that he saw passage of the measure as a test of loyalty to him, saying he had been a “cheerleader” for the party, and warning that any holdouts “wouldn’t be a Republican much longer.”But he minimized the very real rifts within his party that could derail the measure, saying there were “one or two grandstanders” holding it up.That is not the case. Several Republican factions have expressed concern about the details of the sprawling bill, which would extend the 2017 tax cuts and eliminate taxes on tips and overtime pay; raise spending on the military and immigration enforcement; and cut Medicaid, food stamps, education and subsidies for clean energy to pay for some of it.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump Plan Would Tie Some Drug Prices to What Peer Nations Pay

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      The president announced an executive order aimed at lowering U.S. drug costs, revisiting an idea that was blocked in court during his first term.President Trump will sign an executive order on Monday aimed at lowering some drug prices in the United States by aligning them with what other wealthy countries pay, he said on Truth Social on Sunday evening.The proposal he described, which alone cannot shift federal policy, is what he calls a “most favored nation” pricing model. Mr. Trump did not provide details about which type of insurance the plan would apply to or how many drugs it would target, but he indicated that the United States should pay the lowest price among its peer countries.“Our Country will finally be treated fairly, and our citizens Healthcare Costs will be reduced by numbers never even thought of before,” he wrote in his social media post.Any such plan will most likely be subject to challenges in court, and it is not clear whether it will pass legal muster, especially without action by Congress.In his first term, Mr. Trump tried unsuccessfully to enact a version of this idea for Medicare, the health insurance program that covers 68 million Americans who are over 65 or have disabilities. That plan would have applied only to 50 drugs, administered at clinics and hospitals, that are paid for by Medicare. A federal court blocked it, ruling that the administration had skipped steps in the policymaking process.The pharmaceutical industry bitterly opposes the idea, which would almost certainly cut into its profits, and has been lobbying against it as discussions of the policy have regained steam in Washington in recent weeks. Companies have warned that such a policy would lead them to spend less on research, depriving patients of new medicines.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Why Patients Are Being Forced to Switch to a 2nd-Choice Obesity Drug

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      CVS Caremark decided to stop offering Zepbound in favor of Wegovy for weight loss. It’s the latest example of limits imposed by insurance that disrupt treatments for patients.Tens of thousands of Americans will soon be forced by their health insurance to switch from one popular obesity drug to another that produces less weight loss.It is the latest example of the consequences of secret deals between drugmakers and middlemen, known as pharmacy benefit managers, that are hired by employers to oversee prescription coverage for Americans. Employers pay lower drug prices but their workers are blocked from getting competing treatments, a type of insurance denial that has grown much more common in the past decade.One of the largest benefit managers, CVS Health’s Caremark, made the decision to exclude Zepbound in spite of research that found that it resulted in more weight loss than Wegovy, which will continue to be covered.Those research findings, first announced in December, were confirmed in an article published on Sunday in The New England Journal of Medicine. The study involved a large clinical trial comparing the drugs that was funded by Eli Lilly, the maker of Zepbound. Earlier research not financed by Eli Lilly reached similar conclusions.Ellen Davis, 63, of Huntington, Mass., is one of the patients affected by Caremark’s decision. “It feels like the rug is getting pulled out from under my feet,” she said.After taking Zepbound for a year, she has lost 85 pounds and her health has improved, she said. She retired after working for 34 years at Verizon, which hired Caremark for her drug coverage.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      UnitedHealth’s Move to End Cyberattack Loan Lifeline Upsets Medical Providers

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      The company lent roughly $9 billion to practices affected by a vast cyberattack on its payment systems last year. Medical practices are now suing the health care colossus, saying it is pressuring them to repay funds.Two independent medical practices in Minnesota once hoped to expand operations but have spent the past year struggling to recover from the cyberattack on a vast UnitedHealth Group payment system.Odom Health & Wellness, a sports medicine and rehabilitation outfit, and the Dillman Clinic & Lab, a family medicine practice, are among the thousands of medical offices that experienced sudden financial turmoil last year. The cyberattack against Change Healthcare, a division of United, paralyzed much of the nation’s health-care payment system for months.Change lent billions of dollars to medical practices that were short on cash but has begun demanding repayments.Dillman and Odom are suing United in U.S. District Court in Minneapolis, accusing the corporation of negligence related to the cyberattack and claiming they sustained excessive expenses because of the attack’s fallout.In addition, Odom and Dillman asserted in court filings that the company’s insurance arm, UnitedHealthcare, has in turn been denying claims to cover patient care for being submitted late.Lawmakers viewed the chaos caused by the cyberattack as a result of United’s seemingly insatiable desire to buy up companies like Change, alongside doctors’ practices and pharmacy businesses. The widespread disruption was a reminder of how deeply United’s sprawling subsidiaries had become embedded in the nation’s health care system.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 188 Shares199 Views

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      Have you seen examples of health care fraud, waste or abuse? Tell us about it.

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      New York Times reporters are looking into cases of unnecessary and wasteful spending in government health programs.In 2023, companies billed Medicare for hundreds of thousands of urinary catheters that doctors never ordered. The next year, doctors collected billions from the government for pricey bandages that were sometimes unneeded.Medicare waste has wide-reaching consequences. Even if patients do not pay the bills themselves, more spending by the government insurance program can increase future premiums.The New York Times wants to better understand what fraud, waste and abuse looks like in today’s health care system. Are there other instances of wasteful spending we should be investigating? Tell us about them. We are especially interested in cases that involve federal health care programs, like Medicare, Medicaid and Veterans Affairs.We will follow up with you before publishing any part of your response or your name.Help us investigate health care waste, fraud and abuse More

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      How Much Should Weight Loss Drugs Like Wegovy and Zepbound Cost?

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      A new study found that fair prices for medications like Wegovy and Zepbound would be hundreds less per month than they are now.It’s easy to make a medical case for blockbuster weight loss drugs like Wegovy and Zepbound, which have been shown to prevent heart attacks and strokes and save lives.But for the employers and government programs being asked to pay for the medications, the financial case for them is less clear. Are the drugs’ benefits worth their enormous cost?The answer right now is no, according to a new study published on Friday in the journal JAMA Health Forum, by researchers at the University of Chicago.To be considered cost effective by a common measure used by health economists, the price of Novo Nordisk’s Wegovy would need to be cut by over 80 percent, to $127 per month, the researchers concluded. And Eli Lilly’s Zepbound would be cost effective only if its price fell by nearly a third, to $361 per month. (Zepbound warranted a higher price, the researchers said, because it produced greater benefits in clinical trials.)“There’s no doubt that the drugs are demonstrating tremendous health benefits,” said David Kim, a health economist at the University of Chicago and the senior author of the study, which was funded by government grants. “The problem is the price is too high.”There’s widespread hope that the drugs will effectively pay for themselves in the long run, by making patients healthier and preventing expensive medical bills. It’s not clear yet whether that will turn out to be true.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How Covid Changed the Lives of These 29 Americans

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      Five years ago, Covid took hold and the world transformed almost overnight. As routines and rituals evaporated, often replaced by grief, fear and isolation, many of us wondered: When will things go back to normal? Could they ever? Today, for many, the coronavirus pandemic seems far away and foggy, while for others it’s as visceral […] More

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      What Can House Republicans Cut Instead of Medicaid? Not Much.

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      The math of the G.O.P.’s goals makes the move almost unavoidable.The House passed a budget resolution Tuesday night after the speaker, Mike Johnson, persuaded several Republican lawmakers, including those who have expressed reservations about possible Medicaid cuts, to support the bill.In theory, the budget, which kicks off the process of passing an extension of tax cuts enacted in 2017 and up to $2 trillion in spending cuts meant to partly offset them, could become law without significant cuts to Medicaid. But it won’t be easy. More