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Grand Jury
Investigation into Fraudulent Dental Insurance Claims

On January 18, 2012, the District Attorney’s Office charged 71-year-old Dr. Owen Rogal of Philadelphia, and his daughter, 50-year-old Kim Rogal of Delaware, with submitting fraudulent medical bills to numerous private insurance companies worth close to 5 (m) million dollars. These charges are the result of a 15 month investigation by the Philadelphia County Investigating Grand Jury and the District Attorney’s Insurance Fraud Unit. The case was referred to the District Attorney’s Insurance Fraud Unit by the National Insurance Crime Bureau. The Grand Jury found that Dr. Rogal, who is a dentist, and Ms. Rogal used a legitimate business, The Pain Center at 501 South 12th street, to systematically defraud 15 insurance companies by knowingly submitting falsified billing documents for reimbursement. The Rogals were 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.

The Grand Jury investigation examined the Rogals’ billing practices covering a period from mid 2002 through the beginning of 2011. During the investigation, the Grand Jury heard from over twenty witnesses and reviewed hundreds of documents. The evidence presented established that doctors working for the Rogals at the Pain Center were performing a procedure that the Rogals referred to as Radio Frequency Surgery (RFS). RFS, as performed at the Pain Center, is an intra-muscular procedure during which tissue is destroyed using heat generated by a radio signal. This was done by inserting a needle into the affected muscle, and the Rogals claimed that this procedure could alleviate chronic pain. Based on the testimony of experts, 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 for each RFS treatment. The Rogals 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 Rogals 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 and found it to be part of the Rogals’ scheme 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. Of the more than 5 (m) million dollars billed to insurance companies, the Rogals were able to pocket more than 1 (m) million dollars in their personal accounts.

Assistant District Attorney Vicki Markovitz and Detective Karl Supperer are specially assigned to this case. Dr. Rogal and Kim Rogal each face a maximum sentence of 317 years in prison and a fine of $613,000. The investigation into the Rogals is ongoing and anyone with information is urged to contact the District Attorney’s Office

The complete Presentment is available here: Download the full PDF