November 19, 2013: The Honorable Earl W. Trent Jr. today, sentenced 73 year old Dr. Owen Rogal of Philadelphia to one to seven years in prison for submitting close to five (m) million dollars in fraudulent medical bills to numerous private insurance companies. Rogal’s 52-year-old daughter, Kim Rogal, was sentenced to 11 and ½ to 23 months of house arrest for her role in the fraud. Dr. Rogal and Kim Rogal were also ordered to pay close to $373,000.00 each in restitution to seven different insurance companies.
The Rogals were found guilty of Insurance Fraud and other related charges in May 2013, after a 15 month investigation by the Philadelphia County Investigating Grand Jury and the District Attorney’s Insurance Fraud Unit.
This case began in 2010, when the National Insurance Crime Bureau referred it to the District Attorney’s Insurance Fraud Unit. The Grand Jury ultimately 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 five (m) million dollars billed to insurance companies, the Rogals were able to pocket more than one (m) million dollars in their personal accounts.
Assistant District Attorney John Doyle successfully prosecuted this case.