Whether Respondent's renewal facilities licensure application for a group home contained a falsified fire inspection report, as alleged in the Administrative Complaint; and, if so, what is the appropriate penalty?APD failed to prove by clear and convincing evidence that Rivero knowingly submitted a false fire inspection report. Recommend granting renewal license application.

Whether Petitioner, Agency for Health Care Administration (“AHCA”), is entitled to recoup from Respondent, JRM Pharmacy, Inc., d/b/a Super Drugs Pharmacy (“JRM”), $156,657.05 as Medicaid overpayments; and whether investigative, legal, expert witness costs, and fines should be imposed against JRM.Petitioner established that Respondent's billings to Medicaid resulted in "overpayments."

Whether, in treating a single patient, who was actually an undercover law enforcement agent, Respondent, a medical doctor, violated sections 458.331(1)(m), (q), and (t), Florida Statutes; if so, whether (and what) disciplinary measures should be taken against Respondent's license to practice medicine.Petitioner established by clear and convincing evidence that Respondent violated section 458.331(m) and (t), Florida Statutes, as alleged in the Administrative Complaint.

The issues in this case are whether Respondent, whose license to practice medicine was revoked in Maryland on a malpractice charge, is guilty in Florida of the offense of being disciplined in another jurisdiction; and if so, whether Petitioner should impose discipline on Respondent's medical license within the applicable penalty guidelines or take some other action.Respondent, whose license to practice medicine was revoked in Maryland on a malpractice charge, is guilty in Florida of the offense of being disciplined in another jurisdiction, but the penalty should be reduced based on mitigating circumstances.

The issue for determination is whether Petitioner must reimburse Respondent an amount up to $269,456.35, which sum Petitioner received from the Florida Medicaid Program in payment of claims arising from Petitioner's treating of AIDS patients with infusions of intravenous immune globulin between January 1, 1996, and August 11, 2000. Respondent contends that Petitioner is not entitled to retain the payments in question for several reasons, the principal one being that the subject treatments allegedly were not medically necessary.Petitioner must reimburse Respondent for sums he received from the Florida Medicaid Program in payment of certain claims arising from Petitioner`s treating of AIDs patients with infusions of intravenous immune globulin that were not medically necessary.

The issue for determination is whether Petitioner must reimburse Respondent an amount up to $269,456.35, which sum Petitioner received from the Florida Medicaid Program in payment of claims arising from Petitioner's treating of AIDS patients with infusions of intravenous immune globulin between January 1, 1996, and August 11, 2000. Respondent contends that Petitioner is not entitled to retain the payments in question for several reasons, the principal one being that the subject treatments allegedly were not medically necessary.Petitioner must reimburse Respondent for sums he received from the Florida Medicaid Program in payment of certain claims arising from Petitioner`s treating of AIDs patients with infusions of intravenous immune globulin that were not medically necessary.

Whether the Petitioner, Cesare Raoli, M.D., must reimburse the Respondent, Agency for Health Care Administration, for an alleged overpayment of Medicaid funds for the audit period February 22, 1997 through February 22, 1999.The Agency utilized valid sampling to compute an overpayment as Petitioner`s records do not support the charges billed to Medicaid.

The issue is the amount, if any, by which Petitioner overpaid Respondent for medical services under the Florida Medicaid program. By stipulation, the recommended and final orders address only the overpayment amounts arising from the accounts of 45 patients selected for audit by Petitioner. Petitioner has proposed an extrapolated overpayment of $568,166.79, an administrative fine of $5000, and a five-year termination from the Medicaid program. The parties agreed not to address these issues in this case. After Petitioner issues the final order determining the amount of overpayment for the audited accounts, the parties will try to settle the extrapolation and penalty issues. If they fail to do so, Petitioner will give Respondent another opportunity to litigate these issues. However, the factual record is closed concerning the overpayments during the audit period for the 45 patients. Petitioner suggests in its proposed recommended order that the recommended order should merely find the existence of overpayments for certain procedures and allow Petitioner to calculate the amount of the overpayment. This was not part of the stipulation between the parties. Had this been part of the parties’ stipulation, the administrative law judge would not have accepted this part of the stipulation. In this case, after over two years’ prehearing preparation, the parties have litigated--procedure by procedure--the existence and amount of overpayments for the 45 audited accounts. On these matters, there shall be no more tentative agency determinations, no more points of entry, and no more hearings.Medicaid provider overbilled medicaid $4734 for forty-five patients during audit period.

The issue for determination in this matter is the amount of costs, pursuant to section 409.913(23), Florida Statutes (2020), to be awarded to the Agency, the prevailing party in Case No. 20-2884MPI.As having prevailed in the underlying matter, the Agency is entitled to $17,715.11 as reasonable fees and costs associated with DOAH Case No. 20-2884MPI.