STATE OF FLORIDA DEPARTMENT OF HEALTH

Transcription

1 DEPARTMENT OF HEALTH, STATE OF FLORIDA DEPARTMENT OF HEALTH PETITIONER, v. CASE NO AJ HANDAL, L.C.S.W., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner Department of Health (Department) files this Administrative Complaint before the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling (Board) against Respondent AJ Handal, L.C.S.W., and in support thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of clinical social workers pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 491, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed clinical social worker within the State of Florida, having been issued license number SW At all times material to this Complaint, Respondent's address of

2 record was 1014 Portmoor Way, Winter Garden, Florida At all times material to this Complaint, Respondent was employed by MTS Health Services (MTS). 3. At all times material to this Order, Sandra Mora (Ms. Mora), Respondent's fiancé, was employed by MTS as a targeted case manager. Ms. Mora is not licensed by the Department. FACTS RELATING TO PATIENT A.O. 4. In or about Fall 2015, Patient A.O., a minor child, received clinical social work services through Behavioral Support Services (BSS). Patient A.O.'s BSS case manager was Ms. Mora and his BSS therapist was Respondent. 5. In or about Fall 2015, Respondent and Ms. Mora told Patient A.O.'s mother, M.O., that Medicaid' would no longer pay BSS for services with Patient A.O. 6. Respondent and Ms. Mora directed M.O. to switch Patient A.O. to MTS. When M.O. did so, Respondent and Ms. Mora switched to MTS as well. 1 Medicaid is a state and federal partnership that provides healthcare coverage for selected categories of people with low incomes, who are unable to meet the costs of their medical needs. DOH v. Al Handal, L.C.S.W. 2

3 7. Respondent provided up to two hours of services to Patient A.O. per visit, twice per month, for a maximum total of four hours of services per month. 8. Respondent never provided services to Patient A.O. on the weekends or on consecutive days and never provided any therapy at Patient A.O.'s school. 9. During the period of September 2015, through November 2016, Respondent, billed Medicaid for services rendered two-to-three days per week and on Saturdays and Sundays. 10. Respondent billed Medicaid for 753 hours for a total of $57, The actual amount of services Respondent provided to Patient A.O. was 52 hours for a total of $3, Respondent billed Medicaid for 701 hours of services he did not render to Patient A.O. and $53, in fraudulent charges. 12. Respondent did not provide any services in December 2016, because M.O. and Patient A.O. were out of town in Miami and Tennessee during December Respondent billed Medicaid for 18 days in December, including Christmas Day and New Year's Eve. DOH v. A.1 Handal, L.C.S.W. 3

4 14. Respondent only provided two days of service to Patient A.O. in January Respondent billed Medicaid for 15 days of service in January From December 19, 2016, thorough February 17, 2017, Respondent created 33 billing notes regarding services purportedly provided to Patient A.O. in order to bill Medicaid. 16. Respondent copied two of only three unique treatment notes in the file to create additional fraudulent billing notes. Note one was used initially on December 19, 2016, and was copied and billed 21 other times. Note two was used initially on December 20, 2016, and was copied and billed 10 other times. Note three was used two times. 17. During the period September 1, 2015, through February 6, 2017, Respondent billed Medicaid for 248 days totaling 889 hours of service. The actual amount of services rendered were approximately 50 days totaling 100 hours of service. 18. On or about March 9, 2017, M.O. placed a recorded telephone call to Respondent while being monitored and observed by MFCU During the call, M.O. asked Respondent about the inflated billing on Patient A.O.'s EOB. DOH v. AJ Handal, L.C.S.W. 4

5 20. Respondent indicated that it was a serious matter and that, if questioned as to whether Respondent provided the services he billed for, M.O. should say yes to everything. Respondent told M.O. that she would not get in to trouble for lying to assist in covering up the fraud. Respondent told M.O., "I'll take care of you," indicating Respondent would provide compensation to M.O. in the future. 21. M.O. asked Respondent about the times that M.O. and Patient A.O. were out of town and on vacation. Respondent told her to assist in covering up the fraud, as the authorities would not know that they were on vacation during that time. 22. Between September 1, 2015, through February 28, 2017, Respondent fraudulently billed Medicaid $64, for services not rendered to Patient A.O. FACTS RELATING TO PATIENTS A.B. AN D J.B. 23. Beginning in or about Summer 2016, Patients A.B. and 1B., both minor children, received clinical social work services from Respondent. 24. Respondent provided up to an hour of services during sessions with Patients A.B. and J.B. in their home. Respondent did not provide services at the patient's school. DOH v. A.1 Handal, L.C.S.W. DOH.Case Number

6 25. From December 5, 2016, through February 3, 2017, Respondent created 33 billing notes for services purportedly provided to Patient A.B. and billed to Medicaid. 26. Respondent copied two of only three unique treatment notes in the file to create additional fraudulent billing notes. Note one was used initially on December 5, 2016, and was copied and billed 17 other times. Note two was used initially on December 7, 2016, and was copied and billed nine other times. 27. From December 5, 2016, through February 3, 2017, Respondent created 27 billing notes for services purportedly provided to Patient J.B. and billed to Medicaid. 28. Respondent copied two of three unique treatment notes in the file to create additional fraudulent billing notes. Note one was initially used on December 6, 2016, and was copied and billed nine other times. Note two was initially used on December 8, 2016, and was copied and billed nine other times. Note three was initially used on December 10, 2016, and was copied and billed eight other times. 29. Since on or around Summer 2016, Respondent had provided 18 service hours to Patient A.B. and 16 hours to Patient J.B. DOH v. A3 Handal, L.C.S.W. 6

7 30. Respondent provided no more than 50 service hours cumulatively to Patients A.B. and J.B., at a rate of $76.20 per hour for a total of $3, Respondent billed Medicaid for services to Patient's A.B. and J.B. for hours of service for a total of $69, Between June 20, 2016, through February 27, 2017, Respondent fraudulently billed Medicaid $43, for services he did not render to Patient A.B. 33. Between August 2, 2016, through February 26, 2017, Respondent fraudulently billed Medicaid $31, for services he did not render to Patient J.B. COUNT I 36. Petitioner realleges and incorporates paragraphs one through thirty-five (35) as if fully set forth herein. 37. Section (1)(i), Florida Statutes ( ), subjects a clinical social worker to discipline for willfully making or filing a false report or record. 38. Respondent made and filed billing notes for Patients A.O., A.B., and J.B. which reflected services not actually rendered or inaccurately DOH v. AJ Handal, L.C.S.W. 7

8 reflected services rendered. 39. Based on the foregoing, Respondent violated Section (1)(i), Florida Statutes ( ). COUNT II 40. Petitioner realleges and incorporates paragraphs one through thirty-five (35) as if fully set forth herein. 41. Section (1)(1), Florida Statutes ( ), subjects a clinical social worker to discipline for making misleading, deceptive, untrue, or fraudulent representations in the practice of any profession licensed, registered, or certified under this chapter. 42. Respondent made one or more misleading, deceptive, untrue, or fraudulent representations to the Medicaid program regarding clinical social work services not rendered to Patients A.O., A.B., and J.B. 43. Based on the foregoing, Respondent violated Section (1)(1), Florida Statutes ( ). COUNT III 44. Petitioner realleges and incorporates paragraphs.one through thirty-five (35) as if fully set forth herein. DOH v. A.1 Handal, L.C.S.W. 8

9 45. Section (1)(w), Florida Statutes ( ), subjects a clinical social worker to discipline, for violating any provision of Chapters 491 or 456, Florida Statutes ( ), or any rules adopted pursuant thereto. 46. Section (1)(m), Florida Statutes ( ), subjects a clinical social worker to discipline for making deceptive, untrue, or fraudulent representations in or related to the practice of a profession or employing a trick or scheme in or related to the practice of a profession. 47. Respondent employed a trick or scheme in or related to the practice of clinical social work by billing Medicaid for services not actually rendered to Patients A.O., A.B., and J.B. 48. Based on the foregoing, Respondent violated section (1)(w), Florida Statutes ( ) by violating section (1)(m), Florida Statutes ( ). COUNT IV 49. Petitioner realleges and incorporates paragraphs one through thirty-five (35) as if fully set forth herein. 50. Section (1)(w), Florida Statutes ( ), subjects a clinical social worker to discipline, for violating any provision of Chapters DOH v. A3 Handal, L.C.S.W. 9

10 491 or 456, Florida Statutes ( ), or any rules adopted pursuant thereto. 51. Section (1)(n), Florida Statutes ( ), subjects a clinical social worker to discipline, including restriction, for exercising influence on the patient or client for the purpose of financial gain of the licensee or a third party. 52. Respondent told M.O., Patient A.O.'s parent or guardian, to go along with the inflated Medicaid billing scheme so that he could continue receiving unearned payments from the Medicaid program. 53. Based on the foregoing, Respondent violated section (1)(w), Florida Statutes ( ) by violating section (1)(n), Florida Statutes ( ). COUNT V 54. Petitioner realleges and incorporates paragraphs one through thirty-five (35) as if fully set forth herein. 55. Section (1)(w), Florida Statutes ( ), subjects a clinical social worker to discipline for violating any provision of Chapters 491 or 456, Florida Statutes ( ), or any rules adopted pursuant thereto. DOH v. AJ Handal, L.C.S.W. 10

11 56. Section (1)(r), Florida Statutes ( ), subjects a licensed clinical social worker to discipline for improperly interfering with an investigation or inspection authorized by statute. 57. Respondent interfered with the Medicaid Fraud Control Unit's2 investigation by telling M.O., Patient A.O.'s mother, to go along with the inflated billing and offering her future compensation to cover up or not report Respondent's fraudulent conduct. 58. Based on the foregoing, Respondent violated section (1)(w), Florida Statutes ( ), by violating section (1)(r), Florida Statutes ( ). WHEREFORE, Petitioner respectfully requests that the Board enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent 2 The Medicaid Fraud Control Unit (MFCU) is a unit of the Office of the Attorney General of Florida, authorized by section 16.59, Florida Statutes (2016), to investigate all violations of section , Florida Statutes (2016), Medicaid provider fraud, and criminal violations discovered during those investigations. DOH v. A] Handal, L.C.S.W. 11

12 on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this 12th day of July Celeste Philip, M.D., M.P.H. Surgeon General and Secretary Jl kerm Ifwilphl-eU CLERK DATE FILED DEPARTMENT OF HEALTH DEPUTY CLERK Assize' Sanders JUL b17 Keith Humphrey Assistant General Counsel FL DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL Florida Bar Number (P) (850) ext (F) (850) (E) Keith.Humphrey@flhealth.gov PCP: 7/12/2017 PCP Members: Shyers (Chair), Bolhouse, Douglas DOH v. A) Handal, L.C.S.W. 12

13 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section and , Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the, pursuant to Rule (2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this, Respondent waives the right to request a hearing on the facts alleged in this pursuant to Rule (4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule (5), Florida Administrative Code. Mediation under Section , Florida Statutes, is not available to resolve this. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section (4)1 Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition any other discipline imposed. DOH v. AJ Handal, L.C.S.W. 13