The U.S. Justice Department on Tuesday charged a former investigator for health insurer Anthem Blue Cross, a physician and three others for submitting false claims to insurers.
The Justice Department claims that the individuals submitted "at least $20 million in claims" to several insurers including Anthem for cosmetic procedures not covered by insurance including facials, laser hair removal and Botox injections. The insurers paid about $8 million of those claims.
The indictment alleges that Gary Jizmejian, a former senior investigator at the Anthem Special Investigations Unit, provided Roshanak Khadem, the owner of two clinics in the San Fernando Valley of California, and her employees with confidential insurance billing codes so they could submit fraudulent claims. Jizmejian allegedly helped the clinic submit about $1 million in false claims to Anthem in return for cash.
The Justice Department said Anthem Blue Cross has been cooperating in the investigation of Jizmejian.
The suit also alleges that Khadem, Dr. Roberto Mariano, a physician who helped operate the clinics, and two other clinic employees would induce patients to come to the clinic for free services. They would then take the patients' insurance information and fraudulently bill the insurance.
In addition to Anthem, the clinics also allegedly defrauded the Federal Employees Health Benefits Program, which provides health insurance for federal employees, the International Longshore and Warehouse Union and the Pacific Maritime Association Benefit Plan, which is the health benefit plan that covers longshore workers in Southern California and their dependents.
The other two defendants named in the suit are Marina Sarkisyan, office manager at the clinics, and Lucine Ilangezyan, an employee and insurance biller for the clinics.
All five defendants are charged with one count of conspiracy to commit healthcare fraud and 13 counts of healthcare fraud.
Each count charged in the indictment carries a maximum sentence of 10 years in prison.