Philly Dentist, Daughter Accused in Multi-Million Dollar Fraud Case

Duo accused of billing a low-risk pain operation as a delicate brain procedure

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    NEWSLETTERS

    Philadelphia District Attorney's Office
    Dr. Owen Rogal and Kim Rogal 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.

    A Philly dentist and his daughter are accused of bilking close to $5 million out of numerous insurance companies by submitting falsified medical bills, according to Philadelphia’s District Attorney.

    A 15-month investigation by the grand jury and District Attorney's Insurance Fraud Unit resulted Wednesday in Dr. Owen Rogal, 71, of Philadelphia and Kim Rogal, 50, of Delaware being charged with corrupt organizations, criminal conspiracy, insurance fraud, and both theft and attempted theft by deception, according to officials.

    Dr. Rogal, a city dentist, and his daughter are accused of submitting fraudulent medical bills to insurance companies over the past decade.

    The Rogals used The Pain Center located at 501 S. 12th Street to run their alleged systematic fraud. Of the $5 million billed to insurance companies, the Rogals personally pocketed more than $1 million, prosecutors said.

    Officials allege that the two billed 15 firms at least $4,800 for Radio Frequency Surgery pain treatments worth at most $800.

    "They were notified by the insurance industry that what they were doing was fraudulent -- that they needed to stop," said District Attorney Seth Williams. "and they continued to defraud the insurance industry and all of us that pay into health insurance."

    A press release from prosecutors explained the alleged fraudulent practices:

    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 didn’t buy the Rogals' explanation for the billing discrepancy -- finding it was all designed to conceal the alleged scheme -- and decided to move on with charges, officials said.

    Both Dr. Rogal and his daughter Kim each face up to 317 years in prison and $613,000 in fines.

    The investigation is ongoing, officials said.

    An answering service for Owen Rogal's office said he was unavailable and a message could not be left for Kim Rogal due to a full voicemail mailbox; it was unclear whether they had attorneys.