TRENTON—A dental office billing manager has pleaded guilty for billing insurance companies for dental procedures not rendered, Attorney General Paula T. Dow and Criminal Justice Director Stephen Taylor announced Thursday.
According to Acting Insurance Fraud Prosecutor Riza Dagli, Magdy Rafla, 56, of East Brunswick, pleaded guilty on April 7 to an accusation charging him with second-degree health care claims fraud before Superior Court Judge Frederick P. DeVesa in Middlesex County.
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.
Connect with NJTODAY.NET
Join NJTODAY.NET's free Email List to receive occasional updates delivered right to your email address!