The District Attorney's Office of Philadelphia has charged Owen Rogal, DDS, of Philadelphia and his daughter, 50-year-old Kim Rogal of Delaware, with submitting fraudulent medical bills to 15 private insurance companies worth roughly $5 million.
A grand jury found that the pair knowingly submitted falsified billing documents for reimbursement at the Pain Center in Philadelphia.
The grand jury investigation examined the Rogal's billing practices from 2002 through 2011 and included interviews with more than 20 witnesses and the review of hundreds of documents. They were able to establish that doctors working for the Rogals at the Pain Center were performing a procedure that the Rogals referred to as radiofrequency surgery (RFS).
RFS, as performed at the Pain Center, is an intramuscular procedure in which tissue is destroyed using heat generated by a radio signal. This was done by inserting a needle into the affected muscle, which the Rogals claimed could alleviate chronic pain.
The grand jury found that each RFS treatment had a maximum value of $800, but the Rogals routinely sought a minimum reimbursement of $4,800. They then charged insurance companies by using a billing code for a delicate, high-risk invasive procedure performed on a nerve bundle located in the brain.
When the insurance companies challenged the Rogal's billing practices, the Rogals responded that they were performing essentially the same 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, determining that it was an aspect of their efforts to defraud insurance companies. 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. The Rogals were able to pocket more than $1 million in their personal accounts.
They are each 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. They each face a maximum sentence of 317 years in prison and a fine of $613,000.
