Under the Knife and Under Investigation

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Stethoscope on 100 dollar bills symbolizing financial surveillance

A San Fernando Valley woman, Roshanak Khadem, a.k.a. “Roxanne Khadem,” pleaded guilty to federal criminal charges for conspiring to defraud health insurance companies. Khadem did so by filing millions in fraudulent claims submitted for cosmetic procedures that were either not covered by insurance or were not medically necessary. (If you can’t trust your doctor, who can you trust?)

Khadem owned and operated R&R Med Spa and Nu-Me Aesthetic and Anti-Aging Center which provided clients with aesthetic services. Between January 2012 and April 2016 Khadem and her staff provided patients with cosmetic procedures that she knew were not covered by the patient’s health insurers, including Botox injections, facials, and laser hair removal. Patient health insurance information was provided to the clinics’ insurance biller to be used for false and fraudulent claims. These claims were either for services not provided or for those not necessary. (If you’re looking to make a Botox appointment, I wouldn’t recommend going to these clinics.)

Khadem and her fellow fraudsters would then look at the amount paid by insurance to calculate an amount that patients could use as a “credit” to receive free or discounted cosmetic procedures at the clinics. (Patients did in fact use these “credits” for free or discounted procedures).

Proceeds from the false and fraudulent claims were deposited into bank accounts registered to doctors from the clinics. Khadem eventually took possession of the proceeds through signatory authority and pre-signed checks obtained from the doctors. (These patients thought they were receiving an amazing deal. Too amazing to be legitimate, though.)

In the just over four years that the false and fraudulent claims were submitted, the insurance companies paid out at least $1.3 million. However, prosecutors estimate that the amounts paid from the fraud conspiracy could be as much as almost $8 million. Khadem also failed to report this income on her income tax returns for 2013 through 2015, totaling a tax loss of $453,451. (Is anybody else wondering where the possible $7 million discrepancy is coming from?)

Khadem’s sentence hearing is scheduled for June 27, where she faces a maximum sentence of 13 years in federal prison. The remaining four defendants in the case have also pleaded guilty. Lucine Ilangezyan was sentenced to 18 months in federal prison for one count of conspiracy to commit health care fraud. Gary Jizmejian was sentenced to 18 months in prison after pleading guilty to sending text messages to co-defendants as part of the bribery scheme. Dr. Roberto Mariano and Marina Sarkisyan are awaiting sentencing. (Just remember that if something seems too good to be true, it probably is not a good idea.)

Today’s Fraud of the Day comes from a Department of Justice press release “Sherman Oakes woman Pleads Guilty to Charges for Multimillion-Dollar Scheme to Defraud Health Insurers for Cosmetic Procedures,” on February 8, 2022.

LOS ANGELES – A San Fernando Valley woman pleaded guilty today to federal criminal charges for conspiring to defraud health insurance companies by causing millions of dollars in fraudulent claims to be submitted to provide patients with “free” cosmetic procedures, including Botox injections.

Roshanak Khadem, 54, a.k.a. “Roxanne Khadem” and “Roxy Khadem,” of Sherman Oaks, pleaded guilty to one count of conspiracy to commit health care fraud and one count of subscribing to a false income tax return.

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.