N.J. dental office manager pleads guilty to health care claims fraud

The office manager of an East Brunswick, N.J., dental practice pleaded guilty to cheating insurers out of $45,000 by billing for services never rendered.

Magdy Rafla, 56, made the plea to a charge of second-degree health care claims fraud in a state Superior Court, according to the New Jersey Attorney General’s Office.

Rafla, the billing manager at his wife’s dental practice, admitted that between Feb. 9, 2004, and June 14, 2007, he knowingly falsified the dental records of 66 different patients, adding services never performed. He also admitted to submitting the records to various insurers for payment and reimbursement.

An investigation by the New Jersey Office of the Insurance Fraud Prosecutor found that the dental practice gained $45,000 as a result of Rafla’s fraudulent activity.

As part of the plea deal, Rafla’s wife, Gina Tanios-Rafla, agreed to a five-year dental license supervision, including 364 days of an active suspension. The remainder will serve as a period of probation. The dentist also signed a separate consent judgment ordering her to pay a $50,000 civil fine.

Rafla is scheduled for sentencing Sept. 13 and through the plea, the state recommended a three-year state prison sentence and a $50,000 civil fine.

Do you have questions about embezzlement?  Give Prosperident a call at 888-398-2327 or send an email to requests@dentalembezzlement.com

Content retrieved from: http://ifawebnews.com/2010/04/09/n-j-dental-office-manager-pleads-guilty-to-health-care-claims-fraud/