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TRENTON
- Attorney General Paula T. Dow and Criminal
Justice Director Stephen J. Taylor announced
that a dental office billing manager was
sentenced to state prison today for billing
insurance companies for dental procedures
not rendered.
According
to Acting Insurance Fraud Prosecutor Riza
Dagli, Magdy Rafla, 56, of East Brunswick,
was sentenced to three years in state prison
by Superior Court Judge Frederick P. DeVesa
in Middlesex County. Rafla previously signed
a consent judgment ordering him to pay a
$50,000 civil fine. The sentence was based
on Rafla’s April 7 guilty plea to
an accusation charging him with second-degree
health care claims fraud. Prior to sentencing,
full restitution was paid to the insurance
companies.
In
pleading guilty, Rafla, the billing manager
at his wife’s dental practice located
in East Brunswick, admitted that between
Feb. 9, 2004 and June 14, 2007, he knowingly
falsified the patient dental records of
approximately 66 different patients to include
dental services that were not provided.
He further admitted that he submitted these
records to various insurance companies for
payment or reimbursement. An investigation
by the Office of the Insurance Fraud Prosecutor
determined that, as a result of the fraud,
Rafla’s wife’s dental practice
received $45,000 for the dental services
not performed.
As
part of Rafla’s plea agreement, his
wife, Gina Tanios-Rafla, has agreed to a
five-year dental license suspension, including
364 days of active suspension with the remainder
served as a period of probation. Tanios-Rafla
also signed a separate consent judgment
ordering her to pay a $50,000 civil fine.
Detective
Amy Carson, Civil Investigator Lisa Yildiz
and Deputy Attorney General Steven B. Farman
were assigned to the investigation. Farman
represented the Office of the Insurance
Fraud Prosecutor at the sentencing.
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