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Anthem Fraud Investigator Arrested in Fraud Investigation

By John Commins  
   May 24, 2018

A federal indictment alleges that a former fraud investigator for Anthem Blue Cross took bribes and provided coconspirators with billing codes that would bypass the insurer's fraud protection firewalls.

Five Californians—including a physician and a former fraud investigator—have been arrested and charged in a scheme that submitted bogus claims to health insurers and used some of the proceeds to provide patients with "free" cosmetic procedures, the Department of Justice said.

The arrest follows the unsealing of a federal indictment this week that details a multi-year scheme that lured patients into two San Fernando Valley clinics to receive free cosmetic procedures—including facials, laser hair removal and Botox injections—which were not covered by insurance.

The conspirators allegedly submitted at least $20 million in claims to the insurance companies, which paid approximately $8 million on those claims, the indictment said.

The scam used the patients' insurance information to fraudulently billed insurers for unnecessary medical services or for services that were never provided. In exchange, the alleged scammers calculated a "credit" that patients could use to receive "free" or discounted cosmetic procedures, the indictment said.

One of the coconspirators, Gary Jizmejian, 44, of Santa Clarita, was a former senior investigator at the Anthem Special Investigations Unit, the anti-fraud unit within Anthem.

The indictment alleges that Jizmejian took bribes in exchange for providing his coconspirators with confidential Anthem information that helped them submit fraudulent bills to Anthem.

Indictment: Anthem Fraud Investigator Arrested in Fraud Investigation by HLMedit on Scribd

In September 2012, Jizmejian gave his coconspirators insurance billing codes—CPT Codes—that Jizmejian knew could be used to submit fraudulent claims to Anthem without Anthem detecting the fraudulent claims, the indictment said.

Jizmejian also allegedly gave his coconspirators the billing code for an allergy-related lab test and told them to submit to Anthem large numbers of bills with this CPT code. The coconspirators used this billing code to submit approximately $1 million in fraudulent claims to Anthem, according to the indictment.

Jizmejian allegedly helped mask the fraud at the clinics by helping coconspirators avoid responding to inquiries from fraud investigators, diverting attention of other Anthem SIU investigators away from the clinics, and closing Anthem investigations into fraud at the clinics, the indictment said.

When reached for comment, Anthem Blue Cross issued the following response:

  • Mr. Jizmejian is no longer an Anthem employee.
  • Anthem fully cooperated with the government's investigation.
  • We have no further comment on pending government charges or activity.

The indicted coconspirators were identified as:

  • Roshanak Khadem, aka "Roxanne" and "Roxy" Khadem, 50, of Sherman Oaks. Khadem owned and operated the two clinics at the center of the alleged scheme—R&R Med Spa, which was located in Valley Village until early 2016, and its successor company, Nu-Me Aesthetic and Anti-Aging Center, which operated in Woodland Hills.
  • Roberto Mariano, MD, 59, of Rancho Cucamonga, a physician who helped operate the clinics;
  • Marina Sarkisyan, 49, of Panorama City, who was the office manager at the clinics;
  • Lucine Ilangezyan, 38, of North Hills, an employee and insurance biller for the clinics.

All five defendants are charged with one count of conspiracy to commit healthcare fraud and 13 counts of healthcare fraud. Each count charged in the indictment carries a statutory maximum sentence of 10 years in prison.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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