TRENTON
- Attorney General Paula T. Dow and Criminal
Justice Director Stephen Taylor announced
that a dental office billing manager has
pleaded guilty for billing insurance companies
for dental procedures not rendered.
According
to Acting Insurance Fraud Prosecutor Riza
Dagli, Magdy Rafla, 56, of East Brunswick,
pleaded guilty yesterday (April 7) to an
accusation charging him with second-degree
health care claims fraud before Superior
Court Judge Frederick P. DeVesa in Middlesex
County.
Judge
DeVesa scheduled sentencing for Sept. 13.
The state will recommend that Rafla be sentenced
to three years in state prison. Rafla also
signed a consent judgment ordering him to
pay a $50,000 civil fine.
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 the Rafla’s plea agreement,
his wife, Gina Tanios-Rafla, has agreed
to a five-year dental license suspension,
including 364 days of an 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. DAG
Farman represented the Office of the Insurance
Fraud Prosecutor at the guilty plea hearing.
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