At East County Internal Medicine, we are dedicated to providing ethical, patient-centered care to our community. As internal medicine specialists, we often collaborate with rheumatologists to manage complex conditions like autoimmune diseases. However, recent high-profile cases have highlighted a disturbing trend in the field: some rheumatologists fabricating or exaggerating diagnoses to justify unnecessary treatments and generate profits. This not only erodes trust in healthcare but can also cause real harm to patients through unwarranted medications and procedures. We’re sharing this information to empower our patients and neighbors to stay informed, seek second opinions when needed, and advocate for transparent medical practices.
Understanding the Issue
Autoimmune conditions such as rheumatoid arthritis are serious, lifelong diseases that require careful diagnosis based on symptoms, lab tests, and imaging. Unfortunately, the high reimbursement rates for treatments like biologic infusions and chemotherapy drugs have led to fraudulent schemes in some cases. Prosecutors have uncovered patterns where doctors falsely label patients with these conditions to bill insurers millions, often subjecting individuals—including children and the elderly—to toxic therapies they don’t need. This results in side effects ranging from organ damage to increased infection risks, all while padding the pockets of unethical providers.
Notable Cases Highlighting the Problem
One of the most egregious examples involves Texas rheumatologist Jorge Zamora-Quezada, who was sentenced to 10 years in prison in May 2025 for a scheme involving over $118 million in false claims. He falsely diagnosed thousands of patients with rheumatoid arthritis, prescribing unnecessary chemotherapy and infusions, leading to severe harm like strokes and other complications. In a related earlier conviction, he was tied to a $325 million fraud involving similar tactics. Prosecutors noted that he diagnosed nearly 73% of his Medicare patients with the condition—far exceeding the 13% average among peers.
More recently, in November 2025, Anchorage rheumatologist Claribel Tan and her husband pleaded guilty to over $12 million in healthcare fraud. Specializing in autoimmune diseases, Tan deceived patients by underdosing injections or lying about medications, affecting around 400 individuals who received unconsented treatments.
Other instances include Enrico Arguelles, a former Montana rheumatologist, who settled for $2 million in 2021 over allegations of improper rheumatoid arthritis diagnoses and unnecessary MRIs and infusions. Similar indictments have targeted doctors in Kentucky and Rhode Island for fraudulent billing related to rheumatoid arthritis treatments like Remicade infusions.
These cases are part of broader Department of Justice efforts, with annual takedowns charging hundreds of professionals for billions in fraudulent losses. While most rheumatologists are ethical, these scandals underscore the need for vigilance.
What Can You Do?
If you’re dealing with symptoms of joint pain, fatigue, or other potential autoimmune issues, always:
- Ask for clear explanations of your diagnosis and treatment plan.
- Consider a second opinion from a trusted specialist.
- Review your medical bills and Explanation of Benefits statements for discrepancies.
- Report suspicions of fraud to Medicare (1-800-MEDICARE) or your state’s medical board.
At East County Internal Medicine, we prioritize evidence-based care and transparency. If you have concerns about a diagnosis or need a referral to a reputable rheumatologist, our team is here to help. Together, we can protect our community’s health and hold the system accountable.
Posted by East County Internal Medicine on January 13, 2026.