The chairman of the New Hampshire Board of Mental Health Practice resigned Tuesday, amid an inquiry into how he responded when one of his own employees allegedly had an improper relationship with a client.
Last month, investigators with New Hampshire’s professional licensing agency asked the board to immediately suspend then-chair Samuel Rosario’s license as a clinical social worker, according to a petition obtained by NHPR through a public records request.
The board declined to do so at an emergency meeting on July 17, but voted to initiate a disciplinary proceeding to weigh the licensing agency’s claims. A hearing on the matter is set for Oct. 18.
The Board of Mental Health Practice is charged with licensing social workers, counselors and other mental health professionals, along with drafting rules and policing ethical violations. It has the power to impose sanctions for professional misconduct ranging from reprimands to revoked licenses.
Rosario is the clinical director at LifeWorks Counseling Associates, a telehealth-based practice serving clients in the state. Officials with the New Hampshire Office of Professional Licensure and Certification claim Rosario and LifeWorks CEO David Ferruolo moved too slowly to fire a clinician under Rosario’s supervision, Erik Alonso, after learning he allegedly crossed boundaries with a client.
Rosario and Ferruolo vigorously dispute that. They say they initially planned to phase out Alonso over several months so they could transition his clients to a new provider — but then decided to fire him much sooner once they confirmed the full extent of his actions.
The OPLC petition also raises other questions about oversight at LifeWorks Counseling.
Investigators allege Rosario knew for several months that Alonso was seeing clients without a supervision agreement on file with the state, but failed to report that to the board. Those agreements ensure that clinicians who don’t yet have their licenses are working under the direct guidance of more experienced professionals, and are legally required for them to practice.
OPLC investigators also say Alonso may have seen Medicare or Medicaid clients while employed at LifeWorks, despite a prior health care fraud conviction that bars him from doing so. Federal regulators can fine employers up to $10,000 per violation if they bill federal health programs for any services provided by such individuals. Alonso could not be reached for comment on the allegations.
Speaking to NHPR Wednesday, Rosario claimed it was fairly common for unlicensed clinicians to work without a supervision agreement before the rules were tightened in 2023. He said he is not in charge of billing at LifeWorks and did not know Alonso was banned from Medicare and Medicaid.
He said he resigned from the board for unrelated reasons, including the unpaid workload, and was “saddened” by the whole issue.
“I've spent over 30 years in New Hampshire, caring for New Hampshire residents, families,” Rosario said. “I've never had any issues.”
A second chance
Alonso, the former LifeWorks clinician, began his career as a social worker in Miami in the 1990s, according to court records. In 2015, he and two others pleaded guilty to Medicare fraud in federal court in Florida. Prosecutors said Alonso served as clinical director for a group of mental health clinics that submitted tens of millions of dollars’ worth of false claims to Medicare between 2008 and 2010.
Authorities in Florida revoked his clinical social work license in 2017.
Alonso disclosed his conviction to the mental health board in New Hampshire when he submitted an application as a candidate for licensure in 2023, including a letter explaining the circumstances and expressing remorse.
Ferruolo, LifeWorks’ CEO, hired Alonso before Rosario joined the practice as clinical director. Ferruolo said he’d thoroughly reviewed Alonso’s background and was convinced he deserved another shot. He was also impressed by Alonso’s clinical skills and qualifications, which included a doctorate in psychology and expertise working with bilingual clients and teens.
“We’re social workers,” Ferruolo said. “We’re supposed to give people second chances.”
On July 3 of this year, Adult Protective Services notified OPLC of allegations that Alonso had crossed ethical boundaries with a client and illegally seen Medicare or Medicaid patients, according to the petition OPLC filed with the mental health board on July 16.
Then, on July 9, according to the OPLC petition, Rosario and Ferruolo also reported Alonso to OPLC. Ferruolo said they had learned of allegations of an improper relationship from an insurance company on July 3, and then notified OPLC after conducting an internal investigation.
According to records filed by OPLC, Rosario and Ferruolo’s complaint included allegations that Alonso stopped seeing the client professionally and pursued a “friendship,” had dinner at her home and asked her to co-sign a mortgage — all of which, OPLC says, amounts to “serious professional misconduct.”
OPLC says Ferruolo and Rosario indicated that they planned to fire Alonso for his actions, but that his termination wouldn’t become final until Dec. 1 because he had a large number of clients they needed to transition to other providers.
Allowing Alonso to keep seeing patients for that long, OPLC says, would have violated Rosario’s “duty of protection” to those patients and created “an imminent danger to the public health, safety, or welfare.”
Rosario and Ferruolo vehemently disagreed with that conclusion, saying that OPLC’s narrative is inaccurate. They said that by the time OPLC brought the matter to the state mental health board, they had already moved Alonso’s termination date up to Aug. 1.
Ferruolo said they were responding to an evolving situation. At the time they filed the complaint with OPLC, he said, LifeWorks only had proof that Alonso had a “dual” personal-professional relationship with a client, and had not yet confirmed “the other allegations associated with that relationship.” That’s when they were contemplating a “transition to termination” over several months, according to a timeline he provided to NHPR.
Ferruolo said many of Alonso’s clients had significant mental health issues, and it would have been damaging to simply cut them off from services — but hiring a new provider to take them on could have taken months.
“We did not want to abandon literally dozens of active clients,” Ferruolo said.
However, Ferruolo said they decided within days to fire Alonso on Aug. 1, after confirming additional details about his actions. And LifeWorks ended up firing the clinician even sooner, Ferroulo said, terminating him on July 18 — one day after the Board of Mental Health Practice suspended his privilege to practice.
Rosario said LifeWorks asked OPLC for help navigating the dilemma, but the agency offered little assistance.
“We understand that there was a violation here,” Rosario said, describing their communication to OPLC. “We have a full load of patients that have to be transitioned. What would you suggest that we do?”
OPLC Executive Director Lindsey Courtney declined to comment on LifeWorks’ portrayal of events, saying the investigation was ongoing.
‘Unlawful’ practice, Medicaid billing
OPLC also alleges Rosario failed to report that Alonso had seen clients before meeting all legal requirements.
According to OPLC’s petition, Alonso saw LifeWorks clients for over a year without submitting a signed supervision agreement to the licensing board — a requirement for clinicians who are still working toward licensure, as he was.
It says “clinical records and billing information” show Alonso was treating clients as of April 2022, but he didn’t have a signed supervision agreement until March 2023 and didn’t file it until that May.
Rosario joined LifeWorks a few months before, in January 2023. The OPLC petition, citing notes from supervision meetings between Rosario and Alonso the following month, says Rosario knew or should have known that Alonso “had been actively engaged in unlawful practice,” but failed to report it to licensing authorities.
Rosario said Alonso was technically in violation of state rules. But he said it was not unusual at the time for unlicensed clinicians to practice under licensed professionals, but without formal supervision agreements in place.
He said a 2021 law establishing conditional licenses was meant to tighten oversight of pre-licensed clinicians, though it wasn’t implemented until late 2023 due to delays on the part of the mental health board, which Rosario, who was chair at the time, attributed to difficulties getting a quorum.
“It probably would have made sense to have reported that,” Rosario said. “It would have made sense to actually initiate the supervision agreement at that point, you know, but that didn't happen.”
Rosario said they were waiting for the new rules to come out. He said they ultimately filed Alonso’s supervision agreement in May 2023 after an insurance company’s auditor said it was required because of the 2021 law.
“So we quickly did that,” he said. “We took care of it.”
The OPLC petition also indicates Alonso saw Medicare or Medicaid clients at LifeWorks — despite being excluded from all federal health care programs as a result of his fraud conviction in Florida.
Rosario said that as Alonso’s supervisor, he would discuss the clinical aspects of treatment but didn’t know what insurance Alonso's clients had because he didn’t handle billing. Rosario said Alonso never told him he was banned from federal health programs.
Ferruolo, the CEO, acknowledged that Alonso saw Medicaid clients and the practice billed for that work. He said he knew of the ban but thought that was acceptable as long as Alonso was a pre-licensed clinician and his services were billed under the umbrella of a supervisor.
But a spokesperson for the federal health department’s Office of Inspector General told NHPR that federal law forbids any Medicare or Medicaid payments for services provided by a health care worker who’s been excluded from those programs — whether directly or indirectly.
Ferruolo said he hadn’t known that until NHPR brought it to his attention. He said he had relied on guidance from a lawyer he consulted and assurances from Alonso.
“I guess we’ll be dealing with that consequence when it comes,” Ferruolo said.
