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Inland Empire medical office employees arrested for alleged $540,000 insurance fraud scheme

News: 2019 Press Release

For Release: February 15, 2019
Media Calls Only: 916-492-3566
Email Inquiries: cdipress@insurance.ca.gov
Inland Empire medical office employees arrested for alleged $540,000 insurance fraud scheme
Suspects attempted to scam over $4 million from insurer

INLAND EMPIRE, Calif. — Three medical office employees were arrested Wednesday for allegedly filing over $4 million in false insurance claims for treatments they claimed they received from their employer. The victim insurer paid out over $540,000 of these fraudulent claims. 
 
The California Department of Insurance found that three employees of Diamond Bar ENT Medical Specialty Group, Isabel Guizar, 45, Erika Lopez, 40, and Susie Quezada, 50, 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.”
 
From 2010 to 2016 the three employees submitted over $4 million in false claims to the insurance company. The insurer paid out approximately $540,311 directly to the three employees, which the employees allegedly pocketed for themselves. 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. Quezada was booked into the Los Angeles Sheriff’s Department Century Station. This case is being prosecuted by the Los Angeles District Attorney’s Office. 
 
Media notes:

  • Booking/arrest photos
  • Isabel Guizar, 45, of Fontana – charged with one felony count of PC 550(a)(1) and one felony count of PC 487. Bail has been set at 150,000.
  • Erika Lopez, 40, of Pomona – charged with one felony count of PC 550(a)(1) and one felony count of PC 487. Bail has been set at 100,000.
  • Susie Quezada, 50, of Ontario – charged with one felony count of PC 550(a)(1), one felony count of PC 487, and one felony count of RTC 19705(a)(1). Bail has been set at 125,000.


 
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The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $310 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.

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