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

    • Delegation Spurs Growth

      When was the last time you or your nonprofit board delegated something? Better yet, when was the last time you should have delegated something but didn't? Effective delegation is an art and often lacking, but by following a few simple steps it becomes easier and can spur growth and sustainability in an organization. In the grand scheme, there is no lack of tasks to delegate, and yet few people can do it effectively.

    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

    • (photo courtesy Scotty's Brewhouse)

      Scotty's Brewhouse Begins Franchising

      Indianapolis-based Scotty's Brewhouse is continuing its growth plans. The restaurant has launched a national franchise program in an effort to bring the Scotty's brand to more locations throughout the U.S. Scotty's currently has 17 restaurants, most of which are located in Indiana.

    • Indy Firm Taps Appirio Exec as CEO

      An Indianapolis-based design and innovation consulting firm has named a new chief executive officer. Studio Science says Steve Pruden, who most recently served as senior vice president of human resources with Indy tech company Appirio, will lead the company.

    • Sales Tech Platform Scores Funding Boost

      A less-than-year-old sales technology company has announced a second round of funding. Costello, which bills its platform as a "real-time sales playbook," has secured $2.1 million in seed funding from investors in Indiana -- Collina Ventures LLC Innovatemap Ventures, Elevate Ventures, Innovate Indiana, serial entrepreneur Chris Baggott and Copper Mountain Technologies Chief Executive Officer and former T2 Technologies executive Irena Goloschokin -- as well as...

    • Rural Indiana Facing 'Have/Have-not Situation'

      The CEO of Indianapolis-based Indiana Fiber Network calls the 16-year-old broadband internet provider "a great Hoosier success story." IFN, which was launched with a focus on high-speed connectivity for 20 rural telephone companies, now includes some 4,000 buildings throughout the state plugged-in through a network of more than 4,500 miles of fiber. Despite its growth, Jim Turner says there's still work to be done to bridge the broadband access gap in rural areas.

    • (photo courtesy RQAW Corp.)

      Architecture Firm Set to Open New HQ

      An architecture firm previously located in Indianapolis will Wednesday afternoon cut the ribbon on its new Fishers headquarters. RQAW Corp. says it will also detail its progress toward its job creation commitment to the Indiana Economic Development Corp.