April 19, 2013
Oyster Bay Surgeon Charged With Stealing $37K From Private Insurance Companies
Rafiy billed insurance companies for procedures covered by workers’ comp; faces up to 7 years in prison
MINEOLA, N.Y. – Nassau County District Attorney Kathleen Rice announced today that an Oyster Bay doctor has been arrested and charged with grand larceny and other felonies for stealing more than $37,000 by billing private insurance companies for procedures already covered by workers’ compensation.
Philip Rafiy, 50, was arrested yesterday by DA Investigators and charged with four counts of Grand Larceny in the Third Degree, Scheme to Defraud in the First Degree, seven counts of Falsifying Business Records in the First Degree, and Grand Larceny in the Fourth Degree. He faces up to seven years in prison if convicted. He was released on his own recognizance this morning and is due back in court May 3.
Rice said that between August 2007 and July 2009, Rafiy, an orthopedic surgeon, stole $37,063 from the private health insurance companies of seven patients by billing those companies for medical procedures that were already being paid for by the New York State Workers’ Compensation Board (WCB). State law dictates that medical care relating to injuries suffered in the course of employment must be billed through the employer’s workers’ compensation insurance, and not through the patient’s private health insurance.
The investigation began after the WCB received a complaint from a municipality that noticed Rafiy was improperly billing the municipality and the private insurance of company of one of its employees and was conducted jointly with the Workers’ Compensation Inspector General’s Office.
Rafiy is the owner and operator of LI Spine and Orthopedics, PC in Hicksville, specializing in the field of spinal surgery, orthopedic trauma, arthroscopic surgery, rehabilitation and radiological MRI imaging.
“Double billing for medical procedures is a crime that drives up healthcare costs for everyone," Rice said. “I will continue to aggressively investigate and prosecute any doctor who defrauds the system and betrays patients' trust for personal gain.”
Deputy Chief Andrew Weiss of the DA’s Economic Crimes Bureau is prosecuting the case. Rafiy is represented by Steven Scaring, Esq.
The charges are merely accusations and the defendant is presumed innocent until and unless proven guilty.