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Authorities Uncover $20 Million Health Care Scheme in California Federal authorities arrested five individuals connected to San Fernando Valley clinics and a significant health care fraud scheme. On May 22, a federal grand jury indictment was unsealed. The indictment alleges that the five individuals engaged in a health care fraud conspiracy over multiple years and targeted at least eight health insurance companies and the International Longshore and Warehouse Union, the Pacific Maritime Association Benefit Plan, and the Federal Employees Health Benefits Program. The Conspirators According to the Department of Justice (DOJ) press release, the co-conspirators included: Roshanak “Roxanne” or “Roxy” Khadem, 50: Khadem owned and operated two clinics, R&R Med Spa and Nu-Me Aesthetic and Anti-Aging Center. Dr. Roberto Mariano, 59: Mariano helped operate the clinics. Marina Sarkisyan, 49: Sarkisyan was a clinic office manager. Lucine Ilangezyan, 38: Ilangezyan was an insurance biller for the clinics. Gary Jizmejian, 44: Jizmejian was previously a senior investigator at the Anthem Special Investigations Unit, the insurer’s anti-fraud unit. The Allegations The indictment alleges that the co-conspirators induced patients to visit the clinics for free cosmetic procedures, such as Botox injections, facials, and laser hair removal. These procedures were not covered by insurance. The co-conspirators would gain the patients’ insurance information and bill their insurers for medical services that were unnecessary or never provided. The defendants then used some of the illegally obtained proceeds to calculate a “credit” the patients could use for discounted or free cosmetic procedures. The defendants submitted at least $20 million in insurance claims and were paid approximately $8 million. The indictment also states that Jizmejian, for cash payments, would provide Khadem and others with confidential Anthem information. This information helped the defendants submit fr
30 May 2018, 5:43 am by Gregory J. Brod
Gary Jizmejian, 44: Jizmejian was previously a senior investigator at the Anthem Special Investigations Unit, the insurer’s anti-fraud unit. [read post]
18 May 2011, 3:20 am by Bob Kraft
Of course, that is not preventing the health insurance companies from charging higher and higher premiums. [read post]
17 Jan 2011, 5:00 am
I am confident this happens in every court in the United States.The insurance company will use tactics collectively known as “delay and deny. [read post]
31 Aug 2016, 10:00 am
The health insurance company paid the penalty without admitting or denying the SEC’s allegations. [read post]
31 Aug 2016, 10:00 am
The health insurance company paid the penalty without admitting or denying the SEC’s allegations. [read post]
31 Aug 2016, 10:00 am
The health insurance company paid the penalty without admitting or denying the SEC’s allegations. [read post]
9 Feb 2011, 6:33 am by Stanley D. Baum
United Healthcare Insurance Co., Nos. 10-12942, 10-13222 (11th Circuit 2011) (unpublished opinion), in a suit brought under ERISA, the plaintiff had alleged that the defendant, United Healthcare Insurance Company ("United"), inappropriately denied her claim for out-of-network health care benefits under her employer's group health insurance plan (the "Plan"). [read post]
23 Dec 2010, 2:13 pm by Mark S. Humphreys
In November 1987, Betty Flowers and her husband, Edward Flowers, applied for and were issued a joint life insurance policy with United Insurance Company of America (United). [read post]
10 Jun 2018, 6:17 am by Mark S. Humphreys
Reliable Life Insurance Co. and the 1977, Amarillo Court of Appeals opinion styled, United Savings Life Insurance Company v. [read post]
6 Nov 2016, 5:57 am by Mark S. Humphreys
When the Arkansas insurance commissioner weighed the merits of a hospital’s billing complaint against United Healthcare, her interactions with one of the nation’s largest health insurers extended far beyond her department’s hearing room. [read post]
25 Feb 2020, 9:05 pm by Simone Hussussian
Yet health sharing organizations are not actually treated under the law like insurance companies. [read post]