LAURA J. SCUSSEL, LICSW
NPI 1154432698, individual, Warwick, RI, Social Worker, Clinical
- Hours beyond a day in 5 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code H0004 ($720 per patient-month) sit in the top 5% of every provider billing that code.
- 92% of Medicaid dollars are on codes with a history of abuse.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2019 | More hours than a day holds at a conservative unit price | 5.1 | 46.6 | 31.0 | 40.3 | 166 | 2 | 90834 90853 H0004 H2014 | $81K |
| Jan 2020 | More hours than a day holds at a conservative unit price | 6.4 | 43.0 | 28.7 | 37.0 | 250 | 2 | 90791 90834 90853 H0004 H2014 | $73K |
| Jun 2020 | More hours than a day holds at a conservative unit price | 6.2 | 50.0 | 33.4 | 45.5 | 102 | 1 | 90834 90853 H0004 | $77K |
| Jul 2020 | More hours than a day holds at a conservative unit price | 5.8 | 48.1 | 32.0 | 43.2 | 106 | 1 | 90834 90853 H0004 | $76K |
| Oct 2020 | More hours than a day holds at a conservative unit price | 5.1 | 39.2 | 26.2 | 36.9 | 95 | 1 | 90834 90853 H0004 | $63K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | LAURA J. SCUSSEL, LICSW |
| Type | Individual |
| Status | Active |
| NPI issued | August 31, 2006, last updated November 6, 2019 |
| Practice location | 2756 POST RD., Warwick, RI 02886, 401-691-6000 |
| Specialties | Social Worker, Clinical (1041C0700X, primary, license ISW01397 RI) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| H0004 | Behavioral health counseling and therapy per 15 minhistory of abuse | $2.3M | 81% | $720 | $174 (top 5% from $559) | 96th percentile | |
| 90834 | Psychotherapy, 45 minutes | $202K | 7% | $164 | $101 (top 5% from $318) | 76th percentile | |
| H2014 | Skills training and development per 15 minhistory of abuse | $184K | 6% | $323 | $298 (top 5% from $3K) | 53rd percentile | |
| 90853 | Group psychotherapyhistory of abuse | $92K | 3% | $75 | $60 (top 5% from $332) | 61st percentile | |
| 90837 | Psychotherapy, 1 hourhistory of abuse | $28K | 1% | $125 | $191 (top 5% from $442) | 20th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $10K | 0% | $123 | $105 (top 5% from $228) | 69th percentile | |
| H0036 | Community psychiatric supportive treatment face-to-face per 15 minhistory of abuse | $6K | 0% | $216 | $195 (top 5% from $1K) | too few months to rank | |
| H0040 | Assertive community treatment program per diem | $5K | 0% | $312 | $1K (top 5% from $2K) | too few months to rank |
In this area
6 providers in Kent County, RI carry an indicator in the public record, with $2.8M at stake between them. The most common is part of a provider network, on 4 of them, followed by named in an enforcement record on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | ODYSSEY HEALTHCARE OPERATING B LP Warwick, RI, ranked 1050 | $955K |
|
| 3 | EDEN HOSPICE LLC Warwick, RI, ranked 2934 | $0 |
|
| 3 | 83 CORONA STREET EDEN OPERATIONS LLC Warwick, RI, ranked 6345 | $0 |
|
| 3 | ALTERNATIVE INTEGRATIVE MEDICINE, INC Warwick, RI, ranked 6877 | $0 |
|
| 3 | 4000 POST ROAD EDEN OPERATIONS LLC Warwick, RI, ranked 7215 | $0 |
|
| 5 | MI OK BRUINING Warwick, RI, ranked 10839 | $1.8M |
Recent enforcement in RI
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.