Ex-Anthem Investigator Faces Sentencing in $20M Health Care Fraud Scheme

LOS ANGELES  - A Santa Clarita man who worked as a top fraud investigator for Anthem Blue Cross faces sentencing today for his role in a scheme in which more than $20 million in bogus claims were submitted to Anthem and other insurance companies with his help.

Gary Jizmejian, 48, is 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 company.

In September, he pleaded guilty to one federal count of using a cellphone to aid in a commercial bribery scheme. Prosecutors are asking for an 18-month prison sentence and a $75,000 fine, according to a document filed in Los Angeles federal court.

Jizmejian admitted accepting quarterly payments ranging from $1,000 to $2,500 in exchange for providing co-defendants with confidential Anthem information that helped them submit phony bills to the insurer. He also acknowledged taking a $1,000 payment for using insider information to tip off co-defendants of a federal probe into the scheme.

The defendant ``purposely and deceptively hid years of bribe payments from his employer, who entrusted him to assist them in ferreting out criminal health care frauds, not become entangled in one himself,'' prosecutors wrote, adding that Jizmejian was ``driven to commit this crime because he was greedy and he saw an opportunity to fill his pocket.''

Four others were also charged in what federal prosecutors call a six- year scheme to commit health care fraud against at least eight companies.

Those charged include the owner-operator of two San Fernando Valley clinics, Roshanak ``Roxanne'' Khadem, 53, 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, according to the U.S. Attorney's Office.

The indictment contends that Khadem, the alleged ringleader of the scheme, and her accomplices 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 defendants obtained insurance information from the patients and fraudulently billed insurers for the unnecessary medical services or for services that were never provided, the indictment alleges.

During the course of the alleged conspiracy, Khadem and 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 scheme involving the two clinics 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.

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