NJ electrologist gets 7 years in insurance fraud case

Peter C. Harvey, Attorney General
Division of Criminal Justice
Vaughn L. McKoy, Director
Office of the Insurance Fraud Prosecutor
Greta Gooden Brown, Insurance Fraud Prosecutor

For Immediate Release: October 4, 2005

For Further Information Contact:
John R. Hagerty (609) 984-1936
Division of Criminal Justice

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.

Some people are just greedy and lazy.

Since Insurance DOES cover electrolysis, this was so unnecessary. What she got by doing this was a way to charge more money per session, and get around the approval process.