Former Anthem Employee Charged in Fraud Scheme

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Anthem says operating revenue increased by $1 billion quarter-over-quarter Anthem says operating revenue increased by $1 billion quarter-over-quarter
LOS ANGELES -

A former fraud investigator for Indianapolis-based Anthem Inc. (NYSE: ANTM) is one of five people indicted on federal healthcare fraud charges. The defendants allegedly participated in a multi-year scheme to commit fraud against at least eight health insurance companies.

The U.S. Attorney's Office for the Central District of California says Gary Jizmejian, who previously served as a senior investigator at the Anthem Special Investigations Unit, provided the other defendants with confidential Anthem information that helped them submit fraudulent bills to Anthem in exchange for cash payments. The information included billing codes that could be used to submit the claims without Anthem detecting them as fraudulent.

According to the indictment, Jizmejian provided the billing code for an allergy-related lab test which the defendants used to submit approximately $1 million in fraudulent claims to Anthem. He is also accused to working to prevent the insurance companies from detecting the fraudulent activity.

The indictment says Roshanak Khadem owned two clinics at the center of the alleged scheme and offered "free" cosmetic procedures such as facials and laser hair removals. Khadem and her co-conspirators would then allegedly use the patients' insurance information to fraudulently bill the insurance companies.

Officials say Jizmejian also tipped Khadem off to a federal criminal investigation into the clinics in 2015. The indictment says Khadem and the others submitted at least $20 million in claims to the insurance companies, which paid approximately $8 million on those claims.

The other three defendants include:

  • Dr. Roberto Mariano, a physician who helped operate the clinics
  • Marina Sarkisyan, who was the office manager at the clinics
  • Lucine Ilangezyan, an employee and insurance biller for the clinics

Each defendant faces one count of conspiracy to commit healthcare fraud and 13 counts of healthcare fraud. Each charge carries a statutory maximum sentence of 10 years in prison.

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