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Former Anthem fraud investigator charged in $20M billing operation

May 29, 2018

Five people, including a former investigator for Indianapolis-based health insurer Anthem Inc., have been charged with submitting up to $20 million in false claims to insurers.

Gary Jizmejian, who worked in Anthem’s special investigations unit in California, provided confidential billing information to two clinics in California that helped them submit fraudulent bills to Anthem, authorities said.

That scheme allowed two clinics in the San Fernando Valley to provide patients with free cosmetic procedures—including facials, laser hair removal and Botox injections—which were not covered by insurance.

The U.S. Attorney’s Office for the Central District of California said in a written statement last week that Jizmejian, 44, gave insurance billing codes to the owner of two clinics in the San Fernando Valley, starting in 2012. Jizmejian knew the codes could be used to submit fraudulent claims to Anthem without Anthem detecting them, authorities said.

On one occasion, Jizmejian gave a clinic owner the billing code for an allergy-related lab test and instructed her to submit to Anthem large numbers of bills with that code.

The clinic owner, Roshanak Khadem, 50, of Sherman Oaks, California, and “other members of the conspiracy used this billing code to submit approximately $1 million in fraudulent claims to Anthem,” according to the indictment.

Khadem owned and operated the two California clinics at the center of the investigation: R&R Med Spa, and Nu-Me Aesthetic and Anti-Aging Center.

The indictment also says Jizmejian worked to prevent the insurance companies from detecting the fraud at the clinics, which included diverting attention of other Anthem investigators away from the clinics and closing Anthem investigations into fraud that was being committed at the clinics.

In September 2015, based on confidential information obtained by Anthem, Jizmejian tipped Khadem off about a federal criminal investigation into the clinics.

Anthem cooperated in the investigation, authorities said. The insurer did not return calls to IBJ.

Jizmejian, who lives in Santa Clarita, California, also could not be reached for comment. His LinkedIn page says he was a police officer in Hawthorne, California, for eight years before joining Anthem in 2005.

At Anthem, he was responsible for developing fraud cases to recover corporate and client funds paid on fraudulent claims. He helped recover more than $5 million in monetary losses and “stopped future losses in excess of $20 million,” according to his LinkedIn page.

The other defendants in the case:

•    Dr. Roberto Mariano, 50, of Rancho Cucamonga, California, a physician who helped operate the clinics;

•    Marina Sarkisyan, 49, of Panorama City, California, office manager of the two clinics;

•    Lucine Ilangezyan, 38, of North Hills, an insurance biller for the clinics.

All five defendants were charged with one count of conspiracy  to commit health care fraud and 13 counts of health care fraud. Each count carries a statutory maximum sentence of 10 years in prison.

 

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