TRENTON
- Attorney General Peter C. Harvey announced
that a Passaic County electrologist has
been sentenced to state prison and ordered
to pay restitution for attempting to bilk
several New Jersey insurance companies
out of more than $900,000 in reimbursement
payments by billing common electrolysis
as a medically necessary cosmetic procedure
- a procedure the electrologist was unable
to perform.
“This
investigation and prosecution uncovered
an attempted fraud that nearly cost two
New Jersey insurance companies $1 million.
The Office of Insurance Fraud Prosecutor,
in concert with the insurance industry,
is able to identify potential fraud and
to move quickly to stop the illegal activity,”
said Attorney General Harvey.
According to Vaughn L. McKoy, Director,
Division of Criminal Justice and Greta
Gooden Brown, Insurance Fraud Prosecutor,
Florence Acquaire, 64, Pike Drive, Wayne,
was sentenced on Sept. 30 by Passaic County
Superior Court Judge Randolph M. Subryan
to seven years in state prison and ordered
to pay nearly $70,000 in restitution to
the Aetna and United Health Care Insurance
Companies.
Insurance Fraud Prosecutor Brown noted
that Acquaire was convicted on April 14
by Judge Subryan following a 10-day bench
trial. Acquaire, who operated the High
Mountain Medical Center, 342 Hamburg Pike,
Wayne, was convicted of Health Care Claims
Fraud, theft by deception, and attempted
theft by deception. In finding Acquaire
guilty, Judge Subryan determined that
from July 25, 1998 through April 12, 2001,
Acquaire submitted dozens of fraudulent
health insurance claims seeking more than
$908,843 in reimbursement payments from
the United Health Group Insurance Company
and the Aetna Insurance Company. The Aetna
Insurance Company was billed $843,797,
while United Health Group Insurance Company
was billed $38,120.
A six-count State Grand Jury indictment
returned on Oct. 30, 2003, alleged that
Acquaire fraudulently billed electrolysis
as a surgical debridement procedure -
a medically necessary procedure which
involves the surgical excision of dead
skin and which must be performed by a
doctor or other licensed medical service
provider. Acquaire is not a licensed medical
service provider and was, therefore, not
qualified to perform debridement or other
surgical procedures and was ineligible
to bill insurance companies the higher
cost of the surgical procedure.
The investigation and prosecution was
conducted by the Division of Criminal
Justice - Office of the Insurance Fraud
Prosecutor which investigates and prosecutes
civil and criminal insurance fraud cases.
State Investigators Joseph Luccarelli,
Ronald Williams and Christina Fiscella,
along with Civil Investigators George
Douglas and Andre Mitchell conduced the
investigation. Deputy Attorney’s
General Jacqueline D. Smith and Richard
Queen coordinated the prosecution. Also
assisting in the investigation were Christopher
Trovato of the Special Investigations
Unit of Aetna Insurance Company, John
Rowe, an Investigator for United Health
Group Insurance Company, and Lucy P. Brown
of the Oxford Insurance Company.