STATE OF FLORIDA DEPARTMENT OF HEALTH ORDER OF EMERGENCY RESTRICTION OF LICENSE. Celeste Philip, M.D., M.P.H., State Surgeon General, ORDERS the

Transcription

1 STATE OF FLORIDA DEPARTMENT OF HEALTH Final Order No. DOH ea -MQA JUN FILED DATE - Department of By 4-71-mrrttn-PriorTftri; In Re: Emergency Restriction of the License of Al Handal, L.C.S.W. ORDER OF EMERGENCY RESTRICTION OF LICENSE Celeste Philip, M.D., M.P.H., State Surgeon General, ORDERS the emergency restriction of the license of A.3 Handal, L.C.S.W., (Mr. Handal) to practice as a licensed clinical social worker in the State of Florida. Mr. Handal holds license number SW His address of record is 1014 Portmoor Way, Winter Garden, Florida The following Findings of Fact and Conclusions of Law support the emergency restriction of Mr. Handal's license to practice as a licensed clinical social worker in the State of Florida. FINDINGS OF FACT 1. The Department of Health (Department) is the state agency charged with regulating the practice of clinical social work pursuant to Chapters 20, 456, and 491, Florida Statutes. Section (8), Florida Statutes (2016), authorizes the State Surgeon General to summarily restrict Mr. Handal's license to practice as a licensed clinical social worker in the State of Florida, in accordance with section (6), Florida Statutes (2016). 2. At all times material to this Order, Mr. Handal was licensed as a clinical

2 AJ Handal, LCSW social worker, holding license number SW 12029, in the State of Florida, pursuant to Chapter 491, Florida Statutes. 3. At all times material to this Order, Mr. Handal was employed by MTS Health Services (MTS). 4. At all times material to this Order, Sandra Mora (Ms. Mora), Mr. Handal's fiancé, was employed by MTS as a targeted case manager. Ms. Mora is not licensed by the Department. 5. Targeted case management services (TCM) are authorized by the Social Security Act and implemented in Florida through Chapter 409, Florida Statutes. TCM services assist Medicaid recipients with serious diagnosed mental health conditions to obtain access to needed medical, social, education, and other support services. 6. 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. 7. 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. 2

3 Al Handal, LCSW FACTS RELATING TO PATIENT A.O. 8. 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 Mr. Handal. 9. In or about Fall 2015, Ms. Mora and Mr. Handal told Patient A.O.'s mother, M.O., that Medicaid would no longer pay BSS for services with Patient A.O. 10. Ms. Mora and Mr. Handal directed M.O. to switch Patient A.O. to MTS. When M.O. did so, Ms. Mora and Mr. Handal switched to MTS as well. 11. Mr. Handal 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. 12. Mr. Handal never provided services to Patient A.O. on the weekends or on consecutive days and Mr. Handal never provided any therapy at Patient A.O.'s school. 13. In or about late 2016, or early 2017, M.O. received an explanation of benefits (EOB) which documented that Mr. Handal billed Medicaid for services he never provided. Mr. Handal asked M.O. to discuss the EOB, but M.O. told Mr. Handal that she had discarded the EOB and she felt uneasy discussing the matter with him. 3

4 Al Handal, LCSW 14. In January 2017, Mr. Handal informed M.O. that he would be acting as Patient A.O.'s case manager for MTS while continuing to provide therapy as well. 15. On or about February 23, 2017, MFCU investigator Lieutenant Thomas Cronin (Lt. Cronin) showed M.O. Medicaid billing submitted by Mr. Handal, through MTS, for services rendered to Patient A.O. for September 2015, through November Mr. Handal, through MTS, submitted billing to Medicaid for services rendered two-to-three days per week and on Saturdays and Sundays. 17. Mr. Handal, through MTS, billed Medicaid for 753 hours for a total of $57, The actual amount of services provided by Mr. Handal to Patient A.O. was 52 hours for a total of $3, Mr. Handal, through MTS, billed Medicaid for 701 hours of services he did not render to Patient A.O. and $53, in fraudulent charges. 19. M.O. stated that she and Patient A.O. were out of town in Miami and Tennessee for most of December 2016, and that Mr. Handal did not provide any services to Patient A.O. in December Mr. Handal, through MTS, submitted billing for 18 days in December, including Christmas Day and New Year's Eve. 4

5 A] Handal, LCSW 21. Mr. Handal, through MTS, submitted billing for 15 days in January M.O. told Lt. Cronin that Mr. Handal only provided two days of service to Patient A.O. in January On or about March 1, 2017, Lt Cronin obtained the entire MTS Medicaid file for Patient A From December 19, 2016, thorough February 17, 2017, Mr. Handal created 33 billing notes regarding services purportedly provided to Patient A.O. in order to bill Medicaid. 24. Mr. Handal 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. 25. On or about March 9, 2017, Lt. Cronin met with M.O. and reviewed billing records for Patient A.O. for September 1, 2015, through February 6, During this period, Mr. Handal, through MTS, 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. I Lt. Cronin also obtained the MTS Medicaid files for Patients A.B. and 3.B., discussed later in this Order. 5

6 Al Handal, LCSW 27. On or about March 9, 2017, M.O. placed a recorded telephone call to Mr. Handal while being monitored and observed by MFCU. 28. During the call, M.O. asked Mr. Handal about the inflated billing on Patient A.O.'s EOB. 29. Mr. Handal indicated that it was a serious matter and that, if questioned as to whether Mr. Handal provided the services he billed for, M.O. should say yes to everything. Mr. Handal told M.O. that she would not get in to trouble for lying to assist in covering up the fraud. Mr. Handal told M.O., "I'll take care of you," indicating Mr. Handal would provide compensation to M.O. in the future. 30. M.O. asked Mr. Handal about the times that M.O. and Patient A.O. were out of town and on vacation. Mr. Handal told her to assist in covering up the fraud, as the authorities would not know that they were on vacation during that time. 31. Between September 1, 2015, through February 28, 2017, Mr. Handal fraudulently billed Medicaid $64, for services not rendered to Patient A.O. rider of page left intentionally blank] 6

7 A) Handal, LCSW FAG l S RELATING TO PATIENTS A.B. AND J.B. 32. Beginning in or about Summer 2016, Patients A.B. and J.B., both minor children, received clinical social work services from Mr. Handal. 33. J.M., Patient A.B. and 3.B.'s mother, believed Mr. Handal provided services through Counseling and Behavioral Services of Greater Orlando and she was not familiar with MTS. 34. J.M. told Lt. Cronin that Mr. Handal provided up to an hour of services during sessions with Patients A.B. and J.B. in their home. Mr. Handal did not provide services at the patient's school. 35. The office manager at the patient's school confirmed that Mr. Handal visited the school only once. Mr. Handal told the office manager that he would be visiting Patients A.B. and J.B. weekly. She never saw Mr. Handal at the school again. The school required visitors to sign in and out, and Mr. Handal's name did not appear in any of the school visitor log sheets. 36. D.B., Patient A.B.'s and J.B.'s teacher, also confirmed that she met Mr. Handal only once, Mr. Handal told her that he would be visiting Patients A.B. and J.B. weekly, however, she never saw Mr. Handal at the school again and Patients A.B. and J.B. were never taken out of her classroom to receive services from Mr. Handal. 7

8 AJ Handal, LCSW 37. On or about March 1, 2017, Lt. Cronin obtained the MTS Medicaid file for Patients A.B. and J.B. 38. From December 5, 2016, through February 3, 2017, Mr. Handal created 33 billing notes for services purportedly provided to Patient A.B. and billed to Medicaid. 39. Mr. Handal 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. 40. From December 5, 2016, through February 3, 2017, Mr. Handal created 27 billing notes for services purportedly provided to Patient J.B. and billed to Medicaid. 41. Mr. Handal 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. 42. J.M. told Lt. Cronin that since the Summer 2016, Mr. Handal had 8

9 A3 Handal, LCSW provided 18 service hours to Patient A.B. and 16 hours to Patient J.B. 43. J.M. estimated that Mr. Handal provided no more than 50 service hours cumulatively to Patients A.B. and 3.8., at a rate of $76.20 per hour for a total of $3, Mr. Handal 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, Mr. Handal fraudulently billed Medicaid $43, for services he did not render to Patient A.B. 46. Between August 2, 2016, through February 26, 2017, Mr. Handal fraudulently billed Medicaid $31, for services he did not render to Patient J.B. FAL I S RELATED TO PATIENTS A.O., A.B., AND J.B. 47. In total, between June 20, 2016, through February 28, 2017, Mr. Handal fraudulently billed Medicaid $95, for services he did not render to Patients A.O., A.B., and J.B. FACTS RELATED TO PATIENTS F.K., L.K., A.L., Ad.L., AND J.H. 48. In or about April 2016, through October 2016, Mr. Handal and Ms. Mora provided services to Patients F.K. and L.K. A.K., the primary caregiver for 9

10 A.1 Handal, LCSW Patients F.K. and L.K., denied that Patients F.K. and L.K. received the services listed in Ms. Mora's TCM progress notes, stating, "It never happened." 49. In or about June 8, 2016, through August 8, 2016, A.K. and Patients F.K. and L.K. were out of the United States and in France. Ms. Mora, through MTS, fraudulently billed Medicaid seven times during this period for a total of $ Between April 7, 2016, through February 8, 2017, Ms. Mora, through MTS, fraudulently billed Medicaid for $5, for services not rendered to Patients F.K. and L.K. 51. In or about September 2, 2015, through March 15, 2017, Ms. Mora and Mr. Handal (through June 2016) provided services to Patients A.L. and Ad.L. R.L., the primary caregiver for Patients A.L. and Ad.L., denied that Patients A.L. and Ad.L, received the services listed in Ms. Mora's TCM progress notes. 52. During some of Ms. Mora's visits, she provided R.L. with gifts of $25 Walmart gift cards or school supplies. 53. Between September 2, 2015, through March 15, 2017, Ms. Mora, through MTS, fraudulently billed Medicaid for $10, for services not rendered to Patients A.L. and Ad.L. 54. In or about early 2015, Ms. Mora met twice with B.M., primary 10

11 A3 Handal, LCSW caregiver for Patient J.H., to complete paperwork to arrange services for Patient J.H. Mr. Handal provided services to Patient J.H. four times, before telling B.M. that Medicaid issues prevented him from working with Patient J.H. 55. Between June 6, 2015, through January 12, 2017, Ms. Mora, through MTS, billed Medicaid for hours of service for a total of $3, B.M. stated that this billing was inaccurate, stating "It's not true, no services at all!" Neither MTS, Ms. Mora, nor Mr. Handal provided any services to Patient J.H. during B.M. further denied that Ms. Mora provided any of the services listed in her TCM progress notes. 56. Between June 15, 2016, through January 12, 2017, Ms. Mora fraudulently billed Medicaid for $3, for services not rendered to Patient J.H. FACTS RELATED TO ALL PATIENTS 57. In the course of their practice, licensed clinical social workers must possess good judgment, good insight, and good problem solving abilities; and must accurately perceive, evaluate, assess, diagnose, and treat emotional and mental disorders and dysfunctions of their patients, including behavioral issues. Mr. Handal's conduct of fraudulently billing Medicaid for services not rendered over a period of at least nine months, covering at least three different minor child 11

12 AJ Handal, LCSW patients, and attempting to induce Patient A.O.'s mother to help cover up the overbilling by asking her to lie and offering future financial compensation indicate that Mr. Handal does not possess the good judgment, respect for the laws and rules governing the Medicaid program, or respect for the laws and rules governing practice as a licensed clinical social worker. Based on the above, the continued unrestricted practice of Mr. Handal as a licensed clinical social worker constitutes an immediate, serious danger to the public health, safety, and welfare. 58. Mr. Handal's conduct in fraudulently billing Medicaid over a ninemonth period, with three different clients, and his attempt to induce a patient's mother to cover up the overbilling indicate that his conduct is likely to continue. As a result, only restriction of Mr. Handal's license to practice as a clinical social worker as outlined in this Order will protect the public health, safety, and welfare. CONCLUSIONS OF LAW Based on the foregoing Findings of Fact, the State Surgeon General concludes as follows: 1. The State Surgeon General has jurisdiction over this matter pursuant to sections and (8), Florida Statutes (2016), and Chapter 491, Florida Statutes (2016), as set forth above. 12

13 Al Handal, LCSW 2. Section (1)(i), Florida Statutes (2016), subjects a licensed clinical social worker to discipline, including restriction, for willfully making or filing a false report or record. 3. Mr. Handal violated section (1)(i), Florida Statutes (2016) by willfully making and filing billing notes for Patients A.O., A.B., and J.B. which reflected services not actually rendered or inaccurately reflected services rendered. 4. Section (1)(l), Florida Statutes (2016), subjects a licensed clinical social worker to discipline, including restriction, for making misleading, deceptive, untrue, or fraudulent representations in the practice of any profession licensed, registered, or certified under chapter 491, Florida Statutes. 5. Mr. Handal violated section (1)(l), Florida Statutes (2016), by making 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. 6. Section (1)(w), Florida Statutes (2016), subjects a licensed clinical social worker to discipline, including restriction, for violating any provision of chapter 491 or chapter 456, or any rules adopted pursuant thereto. 13

14 A.1 Handal, LCSW 7. Section (1)(m), Florida Statutes (2016), subjects a licensed clinical social worker to discipline, including restriction, 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. 8. Mr. Handal violated section (1)(w), Florida Statutes (2016), by violating section (1)(m), Florida Statutes (2016), by employing a trick or scheme related to the practice of LCSW by billing Medicaid for services not actually rendered to Patients A.O., A.B., and 3.B. 9. Section (1)(n), Florida Statutes (2016), subjects a licensed 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. 10. Mr. Handal violated section (1)(n), Florida Statutes (2016), by telling 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. 11. Section (1)(r), Florida Statutes (2016), subjects a licensed clinical social worker to discipline, including restriction, for improperly interfering with an investigation or inspection authorized by statute. 14

15 AJ Handal, LCSW 12. Mr. Handal violated section (1)(r), Florida Statutes (2016), by interfering with the MFCU's 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 Mr. Handal's fraudulent conduct. 13. Section (6), Florida Statutes (2016), authorizes the State Surgeon General to summarily restrict a licensed clinical social worker's license upon a finding that the licensed clinical social worker presents an immediate, serious danger to the public health, safety, or welfare. 14. Mr. Handal's continued unrestricted practice as a licensed clinical social worker constitutes an immediate, serious danger to the health, safety, or welfare of the citizens of the State of Florida, and this summary procedure is fair under the circumstances to adequately protect the public. WHEREFORE, in accordance with section (6), Florida Statutes (2016), it is ORDERED THAT: 1. The license of AJ Handal, L.C.S.W., to practice as a licensed clinical social worker, license number SW 12029, is immediately restricted from billing, directly or indirectly, any government program or private insurer for any clinical social work services rendered. 15

16 Handal, LCSW 2. A proceeding seeking formal discipline of the license of A] Handal, L.C.S.W., to practice as a licensed clinical social worker in the State of Florida will be promptly instituted and acted upon in compliance with sections and (6), Florida Statutes (2016). DONE and ORDERED this 3-- day of (U\1"& Celeste P ilip, M.D., M.P.H. Surgeon General and Secretary PREPARED BY: Keith Humphrey Assistant General Counsel Florida Bar Number DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL (P) (850) , ext (F) (850) (E) Keith.Humphrey flhealth.gov 16

17 AJ Handal, LCSW NOTICE OF RIGHT TO JUDICIAL REVIEW_ Pursuant to Sections (6), and , Florida Statutes, the Department's findings of immediate danger, necessity, and procedural fairness shall be judicially reviewable. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing a Petition for Review, in accordance with Florida Rule of Appellate Procedure 9.100, and accompanied by a filing fee prescribed by law with the District Court of Appeal, and providing a copy of that Petition to the Department of Health within thirty (30) days of the date this Order is filed. 17