Aug 14 2008 16:13 AUG-14-2aG8 16:15 _ STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, Vv. CASE NO, 2007-09284 JAMES CUSACK, L.M.H.C., Respondent. / a ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling against the Respondent, James Cusack, L.M.H.C., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practices of clinical social work, martiage and family therapy, and mental health counseling 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 mental health counselor within the state of Florida, having been issued license number MH LMT 6650 on May 30, 2001. 3. Respondent's address of record is 10815 Wrigley Court, Riverview, Florida 33569. Oepartment of Health v. James Cusack, L.M.H.C. 1 Case Number 2007-09284 J:\PSU\Allied Health\Cecella\Board of CSW 491 Cases/Cusack, James\2007-09284\Cusack AC QLU2L-G Aug 14 2008 16:13 AUG-14-2088 16:15 on =, 4, Respondent is employed as a mental health counselor in Tampa, Florida. 5. On or about January 2004 until on or about March 2007, Respondent rendered mental health counseling services to patient C.G., a minor. 6. On or about July 18, 2005, Respondent began providing mental ‘health services to G.G.,‘the mother of patient C.G, as well, 7. C.G. and G. G. were both recipients of Medicaid insurance that was provided to C.G. and G.G. through Amerigroup. 8. C.G. went to Respondent's office for the initial visit when treatment for CG. began. 9. After the initial visit, Respondent saw C.G., and eventually, G.G. at their home only. No other visits were conducted in the office, 10. | Whenever Respondent would conduct these visits to provide treatment to G.G., Respondent would just show up, or he would call and say he was in the area and stop by. None of the visits were pre-scheduled or pre-arranged. 11. When Respondent would stop by for these visits, Respondent would stay for between five and thirty minutes, then leave. 12, Respondent billed G.G"s Medicaid insurance provider for a total of 60 alleged visits for treatment purposes. 13. Respondent did not provide treatment services to G.G. on sixty different occasions. 14. Respondent billed the Medicaid provider for the services provided to G.G. under CPT code 90806. Department of Health v, James Cusack, L.M.H.C. 2 Case Nurnber 2007-09284 : 2:\PSU\Allied Health\Cecelia\Board of CSW 491 Cases/Cusack, James\2007-09284\Cusack AC Aug 14 2008 16:14 AUG-14-2888 16:15 ros _ 15. Current Procedural Terminology codes, or CPT codes, are a listing of ’ descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic. services, and thereby serves as an effective means for reliable nationwide communication among physicians and other healthcare providers, patients, and third parties. CPT is the-most widely accepted medical nomenclature-used to report medical procedures and services under public and private health insurance programs. 16. In order to justify the use of CPT code 90806, the Respondent has to have provided individual psychotherapy in an office or outpatient facility for approximately 45 to 50 minutes, face to face with the patient. 17, Respondent did not spend 45 to 50 minutes with G.G., and Respondent conducted the visits at G.G.’s home, not an outpatient facility or an office. COUNT ONE 18, Petitioner realleges paragraphs one (1) through seventeen (17) as though - -fully set-forth-herein. 19. Section 491.009(1)(i), Florida Statutes, (2005), subjects a licensee to - discipline for willfully making or- filing a false report or record; failing to file a report or record-requireéeHay-state 6F federalaw7-willfillyimpédivg-or-obstructifig-the-fiiing of a report or record; or inducing another person to make or file a false report or record to impede or obstruct the filing of a report or record. Such report or record includes only Department of Health v, James Cusack, L.M.H.C, 3 Case Number 2007-09284 J:\PSU\Allied Health\Cecelia\Board of CSW 491 Cases/Cusack, James\2007-09284\Cusack AC Aug 14 2008 16:14 AUG-14-2888 16:16 _ =, a report or record which requires the signature of a person licensed, registered, or certified under this chapter. 20. Respondent has filed willfully filed a false report with the Medicaid provider program when: | . a) Respondent submitted bills for payment for treatrnent of patient G.G. under CPT code 90806 because Respondent did not spend 45 to 50 minutes with G.G. in an office setting or outpatient facility; or b) Respondent submitted bills to the Medicaid provider program indicating he had treated G.G. for approximately 60 visits. 21. Based on the foregoing, Respondent has violated Section 491,009(1)(i), Florida Statutes, ( 2005), by willfully making or filing a false report or record; failing to file a report or record required by state or federal law; willfully impeding or obstructing the filing of a report or record; or inducing another person to make or file a false report or record to impede or obstruct the filing of a report or record. COUNT TWO 22. Petitioner realleges paragraphs one (1) through seventeen (17) as though ~ fully set forth herein 23. Section 491.009(1)(I), Florida Statutes, (2005), subjects a licensee to discipline for making misleading, deceptive, untrue, or fraudulent representations in the practice of any profession licensed, registered or certified under this chapter. 24. Respondent has made deceptive, untrue, or fraudulent representations in or related to the practice of mental health counseling by: Department of Health v, James Cusack, L.M.H.C, 4 Case Number 2007-09284 :\PSU\Allied Health\Cecella\Board of CSW 491 Cases/Cusack, James\2007-09284\Cusack AC Aug 14 2008 16:14 AUG-14-2888 16:16 : Pa? - a) submitting documentation to the Medicaid program provider indicating he had provided services to G.G. over sixty visits when he had not treated her for that many sessions; or . b) billing Medicaid for payment for services under CPT code 90806 when Respondent did not see patient G.G. in an office setting or outpatient facility, and did not-spend 45 to 50 minutes-face to face with G.G. for her treatment session. 25. Based on the foregoing, Respondent has violated Section 491.009(1)(I) Florida Statutes, (2005), by making misleading, deceptive, untrue, or fraudulent representations in the practice of any profession licensed, registered or certified under this chapter. “WHEREFORE, the Petitioner respectfully requests that the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling 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 the Respondent on probation, corrective action and/or any other relief that the Board deems appropriate. Department of Health v. James Cusack, LM.H.C. 5 Case Number 2007-09284 J:\PSU\Allied Health\Cecella\Board of CSW 494 Cases/Cusack, James\2007-09284\Cusack AC” Aug 14 2008 16:15 AUG-14-2888 16:16 a P.88 if SIGNED this day of , 2008. Ana M. Viamonte Ros, M.D., M.P.H.. State Surgéon General Cecelia D. Jefferson : Assistant General Coulnse kL Florida Bar Number 0007609 DEPARTH, Department of Health 6 PUN, CLE EALTH Prosecution Services Unit LEAK; RL, 4052 Bald Cypress Way, Bin C-65 PATE 2T- O9 Tallahassee, FL 32399-3265 2 (850) 245-4640 (850) 245-4684 FAX PCP Date: 777 Fr ae PCP Members: og 5, 2 Department of Health v, James Cusack, L.M.H.C. 6 Case Number 2007-09264 1:\PSU\Allied Health\Cecelia\Board of CSW 491 Cases/Cusack, James\2007-09284\Cusack AC Aug 14 2008 16:15 AUG-14-2888 16:16 % ‘NOTICE OF RIGHTS ; Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be répresented 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. 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 456.072(4), 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 to any other discipline imposed. Department of Health v. James Cusack, L.M.H.C. : 1 7 Case Number 2007-09284 T:\PSU\Allied Health\Cecella\Board of CSW 491 Cases/Cusack, James\2007-09284\Cusack AC

Docket for Case No: 08-003945PL