Five people—including a Santa Clarita man—linked to a pair of San Fernando Valley clinics were arrested this week on federal healthcare fraud charges for allegedly participating in a scheme in which more than $20 million in bogus claims were submitted to health insurance companies.
A federal grand jury indictment unsealed early Tuesday in Los Angeles alleges that the five defendants —including a former fraud investigator at Anthem Blue Cross —engaged in a multi-year conspiracy to commit health care fraud against at least eight health insurance companies, according to the U.S. Attorney’s Office.
Those arrested include the owner-operator of the clinics, Roshanak “Roxanne’’ Khadem, 50, of Sherman Oaks. Khadem owned and operated R&R Med Spa, located in Valley Village until early 2016, and its successor company, Nu-Me Aesthetic and Anti-Aging Center, which operated in Woodland Hills, federal prosecutors said.
The indictment alleges that 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.
The conspirators obtained the insurance information from the patients and fraudulently billed insurance companies for unnecessary medical services or for services that were never provided, the indictment alleges.
Using the fraudulent proceeds from the insurance companies, Khadem and other conspirators calculated a “credit’’ that patients could use to receive “free’’ or discounted cosmetic procedures, prosecutors allege.
During the course of the alleged conspiracy, Khadem and her associates submitted at least $20 million in claims to the insurance companies, which paid about $8 million on those claims, according to the indictment.
The other four defendants arrested are:
—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;
—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, in return for cash payments, Jizmejian assisted Khadem and others by providing them with confidential Anthem information that helped them submit phony bills to the insurer.
The scheme involving 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, according to prosecutors. Another alleged victim was the Federal Employees Health Benefits Program, which provides health insurance for federal employees.
The defendants are charged with one count of conspiracy to commit health care fraud and 13 counts of health care fraud. Each count carries a sentence of up to 10 years in prison, according to the U.S. Attorney’s Office.