Does Medicaid demand accountability for doctors for dishonorable or even illegal behavior?

A Texas pediatrician’s controversial social media post mocking flood victims, insinuating that it would be good if Trump supporters were not protected from the disaster, and suggesting that people who voted for Trump deserve to die, raises larger questions about whether federal health officials are using any tools to hold doctors registered to provide services under Medicaid or other government programs accountable. 

In fact, a review of the federal database used for Medicaid billing shows that the federal government has repeatedly failed to remove doctors from the system who have been convicted of crimes ranging from fraud to improperly distributing opioids, calling into question the health administration’s willingness to hold medical professionals accountable for the appropriate standards of conduct and care.

According to the Department of Health and Human Services (HHS), individual Medicaid programs vary according to each state’s statutes within broad Federal guidelines. Medical professionals are responsible for knowing and abiding by state-specific rules where they furnish services and for each of the programs for which they furnish services.

"They deny climate change. May they get what they voted for."

While the Texas pediatrician has not been charged with any crimes, nor is she accused of malpractice, fraud or doing anything else illegal, the situation raises the question of whether health officials can use government tools to manage the arguably anti-social behavior of physicians who receive government funding through programs like Medicaid. 

The pediatrician, identified by multiple outlets as Christina Propst, a former employee of Blue Fish Pediatrics, took to social media as the natural disaster was still unfolding in central Texas. So far, the floods have claimed the lives of more than 100 people, including children staying at a summer camp near one of the flooded rivers. Blue Fish’s website indicates that patients can use their Medicaid coverage for visits to the practice. 

“May all visitors, children, non-Maga voters and pets be safe and dry,” the posting said. “Kerr county Maga voted to gut FEMA. They deny climate change. May they get what they voted for.” She added, “Bless their hearts,” which can often be used as an insult in the U.S. South.

Reacting to a tidal wave of public outrage at Propst's political rant — posted while rescuers were still searching for victims — Blue Fish Pediatrics terminated Propst following the incident. They did not identify her by name in a statement condemning the comments but her biography was scrubbed from the medical office's website.

“We strongly condemn the comments that were made in that post. That post does not reflect the values, standards or mission of Blue Fish Pediatrics. We do not support or condone any statement that politicizes tragedy, diminishes human dignity, or fails to clearly uphold compassion for every child and family, regardless of background or beliefs,” the practice said. 

The doctor’s comments on the disaster are striking, even in a politically polarized era, but a look at Texas' standards of conduct for physicians does not appear to disqualify doctors who post their political views — no matter how abhorrent their community feels those views may be. The Texas Medical Board, with the blessing of the state legislature, does indeed disqualify people from medical practice persons who are convicted of a felony among other things.

While there are Texas statutes governing "unprofessional conduct", it is far from clear that Propst's postings meet the standard. Texas law lists "prohibited practices" by physicians, of which they define "unprofessional or dishonorable conduct" as making statements "likely to deceive or defraud the public." 

While Propst's behavior may be said to dishonor the profession, it would be a stretch to argue that her screed proposed a commercial transaction tantamount to fraud. 

Doctors' criminal acts ignored by the database of Medicaid-qualified physicians

The U.S. Centers for Medicare & Medicaid Services manages doctors eligible for federal funding. A listing in the NPI records issued by the National Plan & Provider Enumeration System is mandatory for providers in order to bill Medicaid for services. That database is widely used by private insurers as a unique identifier for physicians. 

The NPI registry discloses to the public — in bold-faced type no less — that "Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed."

The database shows at least four physicians accused and convicted of crimes ranging from defrauding Medicare to improperly prescribing opioids, yet they remain in the national database of approved physicians despite those convictions. A person choosing a Medicaid-authorized physician would have to search the individual database of that state's medical board to see if their license was suspended or revoked.

In February, New York doctor Alexander Baldonado was convicted under federal law of a $24 million Medicare fraud scheme where he submitted false claims to the program for “medically unnecessary” tests and orthotic braces, the Justice Department said. 

According to the court documents, Baldonado was also accused of receiving thousands of dollars in kickbacks and bribes in exchange for ordering those laboratory tests that were billed to Medicare from two locations in New York. He authorized hundreds of expensive cancer genetic tests for patients that were being tested for COVID-19 in assisted living facilities, adult daycares, and retirement homes. In some cases, the patients never even received their results, prosecutors said. 

Baldonado also received kickbacks from the owner of a medical supply company in exchange for ordering “medically unnecessary” braces for patients. Both of these schemes resulted in Medicare being billed $24 million, $2.1 million of which was paid out to the laboratories and supply company. 

Despite his conviction, Baldonado remains registered in the NPI system as an active provider, records reviewed by Just the News show. The entry, under Dr. ALEXANDER V. BALDONADO M.D., lists a primary practice address in Queens, New York, where the Justice Department said Baldonado lives. 

The New York State Department of Health maintains a website enabling the public to review information about all licensed doctors of medicine and osteopathy who are registered to practice medicine in New York State, yet Baldonado does not appear in a search of that database.

Doctor convicted of falsifying diagnoses still listed

Dr. Jorge Zamora-Quezada was sentenced in May to 10 years in prison for a $118 billion claims scheme that involved falsely diagnosing patients and prescribing them unnecessary, and in many cases, harmful, medications. Despite the conviction, Zamora-Quezada of Texas is still listed in the NPI system, according to the records that match closely with the biographical details provided by prosecutors. 

The trial showed that Zamora-Quezada falsely diagnosed his patients with rheumatoid arthritis and then “administered toxic medications in order to defraud Medicare, Medicaid, TRICARE, and Blue Cross Blue Shield.” 

“The fraudulent diagnoses made the defendant’s patients believe that they had a life-long, incurable condition that required regular treatment at his offices,” the Justice Department said. “After falsely diagnosing his patients, Zamora-Quezada administered unnecessary treatments and ordered unnecessary testing on them, including a variety of injections, infusions, x-rays, MRIs, and other procedures—all with potentially harmful and even deadly side effects.” 

With his fraudulent proceeds, Zamora-Quezada funded a “luxurious lifestyle” that included a private jet and a luxury property on the water, prosecutors said. 

The Texas Medical Board's website for searching physicians' licenses shows that Zamora-Quezada's license to practice medicine in Texas was canceled in March 2021, but he apparently moved his registration to different states. In September 2024, the Massachusetts Board of Registration in Medicine issued a statement saying that "the Board revoked Dr. Jorge Zamora-Quezada’s right to renew his medical license after it found that Dr. Jorge Zamora-Quezada had been convicted of multiple criminal charges including Health Care Fraud, and had been disciplined by the Texas and Arizona Medical Boards for reasons substantially similar to those for which Massachusetts could impose discipline."

The Massachussetts Board also said that "Dr. Zamora-Quezada had been licensed in Massachusetts from June 3, 1987 until his license was summarily suspended on June 14, 2018" which predates his Texas suspension by three years, and preceded his conviction this year by seven years.

"Pill mill" doctor convicted, license suspended, but still registered to bill Medicaid

Another doctor, David Allingham from Virginia, was sentenced earlier this year to 13 years in prison for running an opioid pill-mill out of his practice and is still listed in the federal database as an active provider, the records show. 

Allingham was sentenced related to a conviction for “conspiring to distribute oxycodone and amphetamines, maintaining drug premises, and false statements relating to health care matters,” according to a Justice Department press release. 

Allingham, the sole owner of Oakton Primacy Care Center in Virginia, wrote prescriptions for opioids and amphetamines for several patients without assessing their individual needs, prosecutors said. From April 2019 to January 2024, Virginia pharmacies filled more than 7,000 prescriptions for oxycodone prescribed by Allingham, the press release says. 

The trial showed that Allingham frequently ignored patient drug tests. In one instance, he continued to prescribe opioids to a patient that had tested positive for cocaine use and false entered records indicating the test was only detecting cocaine present on a dollar bill the patient had touched. 

Tragically, several of Allingham’s patients died of drug overdoses within “hours, days, or weeks” of receiving oxycodone prescriptions from Allingham, the Justice Department said.

The Virginia Department of Health Professions also maintains a website through which citizens can determine the professional status of their physician, and indeed, despite being listed in the NPI, Allingham's record in Virginia shows that his license is suspended.  

The lack of synchronicity between the various state licensing databases and the NPI would indicate that it is likely that tens of millions of dollars earmarked for Medicaid to heal or comfort the citizenry have been siphoned off by unscrupulous — and in some cases unlicensed — physicians who are still listed as "eligible" to file for payments from Medicaid.