Medical Office Assistants Arrested for Attempting to Scam Insurer Out of $4 Million

DIAMOND BAR, Calif. – Three Inland Empire women were arrested on Wednesday for their alleged involvement in a $540,000 insurance fraud scheme.

The women, who were medical office employees, attempted to scam the insurer out of $4 million by filing false insurance claims for treatments they claimed they received from their employer at Diamond Bar ENT Medical Specialty Group. The insurer paid $540,000 directly to the three employees who the California Department of Insurance said the women pocketed.

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Isabel Guizar, 45, of Fontana, Erika Lopez, 40, Pomona, and Susie Quezada, 50, of Ontario allegedly submitted false claims to the insurance company for treatments they claimed they received from their employer. Treatments included nasal surgeries, laryngoscopy biopsies, impaction removals, swallowing dysfunction, nystagmus tests, nasal injections, and therapeutic vocal cord injections. The employees provided the insurance company with handwritten receipts and altered claim forms and were reimbursed directly for the treatments.

“These arrests send a clear message that we will aggressively pursue apprehension and prosecution of anyone who falsifies insurance claims,” said Insurance Commissioner Ricardo Lara. “These are not victimless crimes. This type of fraud drives up the cost of health insurance when insurers pass the losses along to consumers in the form of higher premiums.”During the period 2010 to 2016, the three employees submitted over $4 million in false claims. One of the suspects, Quezada, has also been charged for embezzling approximately $700,000 from Diamond Bar ENT Medical Specialty Group and filing a false tax return.

Guizar and Lopez were booked into West Valley Jail. Guizar is being held in lieu of $150,000 bail. Lopez is being held in lieu of $100,000. Quezada was booked into the Los Angeles Sheriff’s Department Century Station. Quezada is being held in lieu of $125,000. This case is being prosecuted by the Los Angeles District Attorney’s Office.