Monday, June 4, 2018

Los Angeles Clinic Owner, Physician, Office Manager, Insurance Biller and Former Insurance Investigator Indicted for Health Care Fraud. Charged With Billing for Services Not Provided and Giving Patients Free Cosmetic Procedures for Insurance Information.

On May 22, 2018, five people linked to two Los Angeles (San Fernando Valley) clinics were arrested on federal health care fraud charges for allegedly inducing patients to visit the clinics with promises of "free" cosmetic procedures, using the patients' insurance information to submit fraudulent claims to at least eight health insurance companies and then using some of the fraud proceeds to provide patients with the free cosmetic procedures.

An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty.

The government’s unsealed Indictment claims that Roshanak (“Roxanne” or “Roxy”) Khadem operated two clinics – R and 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. Ms. Khadem was arrested and charged along with four others:

Dr. Roberto Mariano, 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; and

Gary Jizmejian, 44, of Santa Clarita, a former senior investigator at the Anthem Special Investigations Unit, the anti-fraud unit within Anthem that is responsible for investigating health care fraud committed against the insurance company. 

The indictment alleges that Ms. 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. Other individuals in the clinics allegedly obtained the insurance information from the patients and fraudulently billed insurance companies for unnecessary medical services or for services that were never provided. Using the fraudulent proceeds from the insurance companies, Ms. Khadem and other co-defendants allegedly calculated a “credit” that patients could use to receive “free” or discounted cosmetic procedures.

It is alleged that these defendants submitted at least $20 million in claims to the insurance companies, which paid approximately $8 million on those claims, according to the Indictment.
One of the twists in this case is the Indictment's allegation that, in return for cash payments, Mr. Jizmejian assisted Ms. Khadem and others by providing them with confidential Anthem information that helped them submit fraudulent bills to Anthem. In September 2012, Mr. Jizmejian allegedly gave Ms. Khadem insurance billing codes – CPT Codes – that Mr. Jizmejian knew could be used to submit fraudulent claims to Anthem without Anthem detecting the fraudulent claims. Mr. Jizmejian allegedly gave Ms. 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. Ms. Khadem and other defendants in the clinic allegedly used this billing code to submit approximately $1 million in fraudulent claims to Anthem, according to the indictment.

The indictment further alleges that Mr. Jizmejian worked to prevent the insurance companies from detecting the fraud at the clinics, which included helping Ms. 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. Anthem Blue Cross has been cooperating with the investigation involving its former employee. 

In September 2015, based on confidential information obtained from Anthem, Mr. Jizmejian allegedly tipped Ms/ Khadem off about a federal criminal investigation into the clinics, according to the indictment. The Indictment alleges that 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. Another victim was the Federal Employees Health Benefits Program, which provides health insurance for federal employees, according to the Indictment.
All five defendants are charged with one count of conspiracy to commit health care fraud and 13 counts of health care fraud. The indictment contains criminal forfeiture allegations that seek forfeiture of the alleged ill-gotten gains derived from the offense. Each count charged in the indictment carries a statutory maximum sentence of 10 years in prison.

This case was investigated by the United States Department of Labor, Office of Inspector General; the United States Department of Labor, Employee Benefits Security Administration; and the Office of Personnel Management, Office of Inspector General. The United States Marshals Service is providing assistance relating to the asset forfeiture investigation. The case is being prosecuted by the U.S. Attorney's Office, Major Frauds Section.


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