Mental health counselor Paul Cartone placed on probation for insurance billing activities

February 28, 2011

On November 4, 2010, the Arizona Board of Behavioral Health Examiners placed licensed professional counselor Paul Cartone on probation with terms and conditions. 

Cardone owns A New Day Counseling Center (“ANDCC”), which has two locations in Arizona, though Cartone himself lives in New York and employs independently licensed behavioral health professionals to provide psychotherapy to ANDCC clients. 

Due to his location, Cartone does not have routine access to client records though he oversees all ANDCC billing activities.  Two therapists provide a range of therapy services to ANDCC clients.  The Board’s document indicates that Cartone committed the following:

• Completed insurance billing documents for services delivered by the two therapists but acknowledged that he was not aware that different billing codes were to be used, depending on the type of service provided.
  
• Completed insurance document without reviewing client records or speaking either o the therapists to ensure their information provide the insurance companies was accurate.
  
• Failed to maintain any insurance claim forms.
  
• Signed insurance claims forms as if he had provided the services, though they were provide by the aforementioned therapists.
  
• Signed the names of the two therapists on claim forms without their permission and without noting that he was signing on their behalf.
  
• Failed to maintain billing documentation including the date of each claim, the service billed for, the diagnosis, payment source, etc.
  
• According to the Board’s document, in 2007, one of the therapists provided marital counseling to a client and his wife.  Cartone was aware that the client’s insurance did not provide reimbursement for marital counseling so instead of representing that they’d participated in marriage counseling, Cartone submitted individual therapy claims for their sessions.

The Board’s document contains other violations.

Terms of Cartone’s probation include 24 months clinical supervision and a practice audit.

Source: Arizona Board of Behavioral Health Examiners Adverse Action Tracking Form, December 2010.