A Philadelphia dentist has been handed a one-to-seven-year state prison sentence for submitting nearly $5 million in fraudulent medical bills to private insurers.
Owen Rogal, 73, who lives and works in the city, was found guilty in May alongside his daughter, Kim Rogal, 52, of insurance fraud and related charges following a 15-month investigation by the Philadelphia County Investigating Grand Jury and the Insurance Fraud Unit of the Philadelphia District Attorney’s Office, according to the prosecutor’s office.
Kim Rogal had previously been sentenced to 11-and-a-half to 23 months of house arrest for her role in the fraud, the record shows.
The grand jury got the case back in 2010 after the District Attorney’s Office was contacted by the National Insurance Crime Bureau.
Investigators ultimately determined that Rogal and his daughter used The Pain Center on South 12th Street to defraud 15 insurance companies by knowingly submitting falsified billing documents for reimbursement, according to the D.A.’s Office.
The Rogals were each initially charged with one count of corrupt organizations, one count of criminal conspiracy, 15 counts of insurance fraud, 12 counts of theft by deception and 10 counts of attempted theft by deception.
The grand jury, which looked at the defendants’ billing practices between 2002 and 2011, heard from more than 20 witnesses and reviewed hundreds of documents throughout its investigation.
Investigators determined that the Rogals routinely sought reimbursement of $4,800 for each Radio Frequency Surgery performed by doctors at The Pain Center.
The procedure, which reportedly destroys damaged muscle tissue using radio signals, actually only had a maximum value of $800, according to the D.A.’s Office.
The defendants charged insurers by using a billing code for a delicate, high risk invasive procedure performed on a nerve bundle in the brain, and when the insurance companies challenged the billing practices, the Rogals claimed they were performing a virtually identical procedure as defined by the brain surgery code and that the part of the body on which the procedure was performed was irrelevant to the amount billed.
“The Grand Jury explicitly rejected this argument and found it to be part of the Rogals’ scheme to defraud insurance companies,” reads a District Attorney’s Office news release. “The Grand Jury further found that the Rogals engaged in business practices that were designed to conceal the true nature of what they were doing in furtherance of this scheme.”
Authorities said the defendants pocketed more than $1 million of the nearly $5 million secured through their fraudulent scheme.