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;
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.
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.
