Former Anthem Employee Charged in Fraud Scheme

Posted: Updated:
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.

  • Perspectives

    • Improving Efficiency At Board Meetings

      Unproductive board meetings waste time, demotivate board members and frustrate staff.  While most boards function relatively well, they may not be functioning at their highest level. Here are several simple changes you can make right now that will keep your meetings productive and on target. Implement a consent agenda. A consent agenda is a single action item at the start of board meetings that typically includes board minutes, financial information, and anything else that may...

    More

Subscribe

Name:
Company Name:
Email:
Confirm Email:
HTML
INside Edge
Morning Briefing
BigWigs & New Gigs
Life Sciences Indiana
Indiana Connections
INPower
Subscribe
Unsubscribe

Events



  • Most Popular Stories

    • Airport Board Approves New Concessions Vendors

      The Indianapolis Airport Authority Board has approved new contracts for several retail and services vendors at Indianapolis International Airport. The contracts are the first of several approvals that are expected as part of the airport's Concessions Refresh initiative, which aims to increase the local focus among vendors. Marsha Stone, senior director of commercial enterprise at the airport, says the effort will be one of the most impactful public-facing projects that...

    • Two Indiana Banks on Forbes Best List

      Forbes has ranked the best banks in the country and Indiana has placed two on the list. First Merchants Bank finished 2nd, and Old National Bancorp came in at 97. The metrics used by the publication include tangible common equity, return on average assets, net interest margin,  efficiency ratio and net charge-offs as a percentage of total loans. 

    • ClearObject Acquired By Equity Firms

      One of Indiana's biggest tech success stories is being acquired. Two equity firms have acquired a majority interest in Fishers-based Internet of Things company ClearObject. The company's headquarters will remain in Fishers and Chief Executive Officer John McDonald will continue to lead the management team. The companies are not releasing financial terms of the transaction. ClearObject was founded in 2010 as CloudOne, and designs, develops and manages Internet of Things-driven...

    • Hard Rock Cafe Indianapolis to Close in March

      Florida-based Hard Rock International has announced that its Indianapolis location will close. The lease for the Hard Rock Cafe Indianapolis space on South Meridian Street is set to expire in March and the company will not renew it.

    • Hotel, Mattress Company to Launch Collaboration

      Jeffersonville-based Bowles Mattress Co. and West Baden Springs Hotel in Orange County will Monday officially launch their new mattress series. The partnership, first announced last month, will make the mattresses that had previously only been made for the resort available to the public.