TRENTON – A dental office billing manager was sentenced to state prison Tuesday for billing insurance companies for dental procedures not rendered, Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor announced.
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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