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Ex-Anthem Investigator Sentenced For SFV Well being Care Fraud Scheme

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A Santa Clarita man who labored as a prime fraud investigator for Anthem Blue Cross was sentenced Monday to a 12 months and a half behind bars for his position in a scheme during which greater than $20 million in bogus claims have been submitted to Anthem and different insurance coverage firms.

Gary Jizmejian, 48, is a former senior investigator on the Anthem Particular Investigations Unit, the anti-fraud unit inside Anthem that’s liable for investigating well being care fraud dedicated towards the corporate. In September, he pleaded responsible to at least one federal rely of utilizing a mobile phone to assist in a industrial bribery scheme.

Together with the jail time period, Jizmejian was ordered to pay a $75,000 superb, in accordance with the U.S. Lawyer’s Workplace.

Jizmejian admitted accepting quarterly funds starting from $1,000 to $2,500 in trade for offering co-defendants with confidential Anthem info that helped them submit phony payments to the insurer. He additionally acknowledged taking a $1,000 fee for utilizing insider info to tip off co-defendants of a federal probe into the scheme.

The defendant “purposely and deceptively hid years of bribe funds from his employer, who entrusted him to help them in ferreting out legal well being care frauds, not turn into entangled in a single himself,” prosecutors wrote in a sentencing memorandum, including that Jizmejian was “pushed to commit this crime as a result of he was grasping and he noticed a possibility to fill his pocket.”

4 others have been additionally charged in what federal prosecutors name a six-year scheme to commit well being care fraud towards not less than eight firms.

These charged embody the owner-operator of two San Fernando Valley clinics, Roshanak “Roxanne” Khadem, 53, of Sherman Oaks. Khadem owned and operated R&R Med Spa, situated in Valley Village till early 2016, and its successor firm, Nu-Me Aesthetic and Anti-Ageing Middle, which operated in Woodland Hills, in accordance with the U.S. Lawyer’s Workplace.

The indictment contends that Khadem — the alleged ringleader of the scheme — and her accomplices induced sufferers to go to the clinics to obtain “free” beauty procedures, together with facials, laser hair elimination and Botox injections which weren’t coated by insurance coverage.

The defendants obtained insurance coverage info from the sufferers and fraudulently billed insurers for the pointless medical companies or for companies that have been by no means offered, the indictment alleges.

Through the course of the alleged conspiracy, Khadem and associates submitted not less than $20 million in claims to the insurance coverage firms, which paid about $8 million on these claims, in accordance with the indictment.

The scheme involving the 2 clinics defrauded the Worldwide Longshore and Warehouse Union, Pacific Maritime Affiliation Profit Plan, which is the well being profit plan that covers longshore staff in Southern California and their dependents, in accordance with prosecutors. One other alleged sufferer was the Federal Staff Well being Advantages Program, which supplies medical health insurance for federal workers.

Khadem is scheduled for trial in February in downtown Los Angeles.

Ex-Anthem Investigator Sentenced For SFV Well being Care Fraud Scheme was final modified: November twenty ninth, 2021 by Contributing Editor

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