John R. Hagerty 609-984-1936

TRENTON - Attorney General Peter C. Harvey announced that two Essex County physicians have been charged by the Division of Criminal Justice - Office of Insurance Fraud Prosecutor with performing unwarranted medical tests and procedures on patients in order to increase insurance reimbursements and, therefore, increase personal profits.

According to Vaughn L. McKoy, Director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden-Brown, a five-count State Grand Jury indictment charged Dr. William M. Burke, 67, Village Road, New Vernon, Morris County, and Dr. Denis S. Schisano, 61, Kent Place Blvd., Summit, Union County, with second degree conspiracy, Health Care Claims Fraud (2nd degree), and attempted theft by deception (3rd degree). The indictment also charges Burke with two counts of unlawfully exposing people to unnecessary radiation (4th degree). A second degree crime carries a maximum penalty of up to ten years in state prison and a fine of up to $150,000, while a third degree crime is punishable by up to five years in state prison and a fine of up to $15,000. A fourth degree crime carries a maximum penalty of up to 18 months in state prison and a fine of up to $10,000. The defendants face possible civil insurance fraud fines pursuant to the Insurance Fraud Prevention Act.

According to Insurance Fraud Prosecutor Gooden-Brown, the State Grand Jury indictment alleges that from January, 1997 to February, 2002, Burke and Schisano, as owner/operators of Orange Mountain Medical Associates, billed insurance companies more than $35,000 for unnecessary patient medical tests and procedures. Orange Mountain Medical Associates operated from three offices located at 77 Main Street, West Orange; 319 Springfield Avenue, Berkley Heights; and 276 Essex Street, Millburn.

The Insurance Fraud Prosecutor’s investigation determined that Burke and Schisano, who specialized in cardiology procedures, routinely prescribed unnecessary cardiac diagnostic testing for patients - even though such tests were not consistent with patient diagnosis or prescribed treatments - in order to bill the Prudential Insurance Company and the Aetna Insurance Company at higher specialist rates. It is alleged that at least 54 patients under treatment for various medical conditions, including facial rash, cyst removal, painful knee, and planter’s wart, were unnecessarily administered cardiac stress tests, electrocardiograms, and other questionable cardiac-related procedures. Additionally, it is alleged that patients were never advised that they were diagnosed with, or tested for, cardiac-related problems or that they were referred for cardiological procedures. I t is also charged that Burke submitted insurance claims for unnecessary X-Rays and, in some instances, failed to take precautions to protect patients from radiation during the administration of X-Rays.

The Division of Criminal Justice - Office of Insurance Fraud Prosecutor has reason to believe that additional patients treated by Burke and Schisano are unaware that they may have been subjected to unnecessary medical treatments. The Office of Insurance Fraud Prosecutor encourages any of Burke and Schisano’s patients to contact the Office of the Insurance Fraud Prosecutor’s toll-free hotline at: 1-877-55-FRAUD

Additionally, complaints may be filed on line via the New Jersey Insurance Fraud Web Page at: www.njinsurancefraud.org.

The indictment was handed up to Mercer County Superior Court Judge Linda R. Feinberg, the Assignment Judge in charge of the State Grand Jury, on Dec. 6. The defendants will be issued complaint summonses and will ordered to appear in Passaic County Superior Court for arraignment and bail.

The investigation was coordinated by State Investigator Lisa Shea, Civil Investigator Julia Ferreira, and Deputy Attorney General Dennis J. Kwasnik assigned to the Division of Criminal Justice - Office of the Insurance Fraud Prosecutor. The investigation was referred to Office of Insurance Fraud Prosecutor by the Professional Boards Prosecution Section of the Attorney General’s Division of Law. Deputy Attorney General Joan Gelber of the Division of Law - Prosecution Section, filed a licensing complaint against the two defendants. The complaint remains pending. The Prudential Insurance Company and the Aetna Insurance Company cooperated with the investigation.

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