SCV man suspected in $20M fraud

Resident 1 of 5 arrested on accusations of submitting fraudulent health care claims to insurance companies

A Santa Clarita man was one of five people arrested Tuesday on federal health care fraud charges, accused of submitting fraudulent claims to health insurance companies and then using some of the fraud proceeds to provide patients with “free” cosmetic procedures.

Garry Jizmejian, 44, a former senior anti-fraud investigator at Anthem Blue Cross, and four others were each charged with one count of conspiracy to commit health care fraud and 13 counts of health care fraud, Thom Mrozek, spokesman for the United States Attorney’s Office, said in news release issued Tuesday.

A federal grand jury indictment unsealed Tuesday morning alleges the five defendants engaged in a multi-year conspiracy to commit health care fraud against at least eight health insurance companies.

Suspects include the owner and operator of the clinics, Roshanak Khadem, also known as “Roxanne” and “Roxy” Khadem, 50, of Sherman Oaks.

Two clinics

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.

The indictment alleges that Khadem and others induced patients to visit the clinics to receive free cosmetic procedures—including facials, laser hair removal and Botox injections—which were not covered by insurance.

The conspirators obtained the insurance information from the patients and fraudulently billed insurance companies for unnecessary medical services or for services that were never provided, according to the news release.

Using the fraudulent proceeds from the insurance companies, Khadem and other conspirators calculated a “credit” that patients could use to receive “free” or discounted cosmetic procedures.

Co-accused

During the course of the conspiracy, Khadem and her conspirators submitted at least $20 million in claims to the insurance companies, which paid approximately $8 million on those claims, according to the indictment.

The other three defendants were identified by the U.S. Attorney’s Office as:

„Dr. Roberto Mariano, 59, of Rancho Cucamonga, a physician who allegedly helped operate the clinics.

„Marina Sarkisyan, 49, of Panorama City, who allegedly was the office manager at the clinics.

„Lucine Ilangezyan, 38, of North Hills, an employee and insurance biller for the clinics.

The suspects are expected to be arraigned on the indictment Tuesday afternoon in the U.S. District Court in downtown Los Angeles.

The indictment alleges that, in return for cash payments, Jizmejian assisted Khadem and others by providing them with confidential Anthem information that helped them submit fraudulent bills to Anthem.

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

Billing codes

Jizmejian gave Khadem the billing code for an allergy-related lab test and instructed her to submit to Anthem large numbers of bills with this CPT code.

Khadem and other members of the conspiracy used this billing code to submit approximately $1 million in fraudulent claims to Anthem, according to the indictment.

The indictment further alleges that Jizmejian worked to prevent the insurance companies from detecting the fraud at the clinics, which included helping Khadem to avoid responding to inquiries from fraud investigators, diverting attention of other Anthem SIU 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 from Anthem, Jizmejian tipped Khadem off about a federal criminal investigation into the clinics, according to the indictment.

The scheme involving the two clinics allegedly defrauded the International Longshore and Warehouse Union, Pacific Maritime Association Benefit Plan, which is the health benefit plan that covers longshore workers in Southern California and their dependents, according to the indictment.

Another victim was the Federal Employees Health Benefits Program, which provides health insurance for federal employees.

The indictment contains criminal forfeiture allegations that seek forfeiture of the ill-gotten gains derived from the offense.

Each count charged in the indictment carries a statutory maximum sentence of 10 years in prison.

The case is being prosecuted by Assistant U.S. Attorney Alexander F. Porter of the Major Frauds Section.