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  8. David Wallace Nam
David Wallace Nam
David Wallace Nam
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Bar #977330(FL)     License for 32 years; Member in Good Standing
Crawfordville FL

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13-003818MPI  AGENCY FOR HEALTH CARE ADMINISTRATION vs HAL M. TOBIAS  (2013)
Division of Administrative Hearings, Florida Filed: Sep. 30, 2013
The issue is the determination of the amount of investigative, legal, and expert witness costs that, pursuant to section 409.913(23)(a), Florida Statutes, Petitioner is entitled to recover from Respondent for ultimately prevailing in DOAH Case No. 10-9318MPI.AHCA limited to reasonable investigative and expert witness costs.
13-004113BID  CARE ACCESS PSN, LLC vs AGENCY FOR HEALTH CARE ADMINISTRATION  (2013)
Division of Administrative Hearings, Florida Filed: Oct. 17, 2013
The issues in this bid protest are whether, in making the decision to award Intervenor Prestige Health Choice, LLC ("Prestige"), a contract to provide Medicaid managed medical assistance services as a provider service network in Region 11 (covering Miami-Dade and Monroe Counties), Respondent Agency for Health Care Administration ("AHCA") acted contrary to a governing statute, rule, or solicitation specification; and, if so, whether such action was clearly erroneous, contrary to competition, arbitrary, or capricious. (In this protest, Petitioner Care Access PSN, LLC ("Care Access"), challenges AHCA's intended award to Prestige in Region 11, and only that award. Care Access does not seek to upset any other intended awards in Region 11 or in any other Region.)The agency's intended contract award, being contrary to the statutes and project specifications, is clearly erroneous and should be rescinded.
10-010840MPI  AGENCY FOR HEALTH CARE ADMINISTRATION vs FLORIDA HOSPITAL ORLANDO  (2010)
Division of Administrative Hearings, Florida Filed: Dec. 22, 2010
Whether Respondent, Florida Hospital Orlando (Respondent or FHO), was overpaid by Medicaid for care provided to patients in the amount of $34,644.10, as alleged by Petitioner, Agency for Health Care Administration (Petitioner or AHCA); or, as Respondent maintains, such care was medically necessary and supported by the record presented in this cause. Petitioner also maintains an administrative fine in the amount of $2,000.00 is warranted in this matter and that it is entitled to recover costs associated with the case in the sum of $7,635.27.Respondent hospital sucessfully established that some of the disputed Medicated claims were supported by records as medically necessary.
12-002868MPI  AGENCY FOR HEALTH CARE ADMINISTRATION vs KENNETH HARDEN, D/B/A KEN CARE, INC.  (2012)
Division of Administrative Hearings, Florida Filed: Aug. 27, 2012
Whether the Agency for Health Care Administration (Agency or Petitioner) is entitled to recover alleged Medicaid overpayments, administrative fines, and investigative, legal, and expert witness costs from Kenneth O. Harden, d/b/a Ken Care, Inc. (Respondent).1/Provider of Medicaid Waiver Program services is liable for repayment of claims when services were rendered not in compliance with Medicaid provider publications adopted by reference as administrative rules.
12-002869MPI  AGENCY FOR HEALTH CARE ADMINISTRATION vs KENNETH HARDEN, D/B/A KEN CARE, INC.  (2012)
Division of Administrative Hearings, Florida Filed: Aug. 27, 2012
Whether the Agency for Health Care Administration (Agency or Petitioner) is entitled to recover alleged Medicaid overpayments, administrative fines, and investigative, legal, and expert witness costs from Kenneth O. Harden, d/b/a Ken Care, Inc. (Respondent).1/Provider of Medicaid Waiver Program services is liable for repayment of claims when services were rendered not in compliance with Medicaid provider publications adopted by reference as administrative rules.
10-002996RX  BAPTIST HOSPITAL, INC., BAY MEDICAL CENTER, HOLMES REGIONAL MEDICAL CENTER, INC., LEE MEMORIAL HEALTH SYSTEM, LIFEMARK HOSPITALS OF FLORIDA, INC., D/B/A PALMETTO GENERAL HOSPITAL, MUNROE REGIONAL MEDICAL CENTER, NORTH BROWARD HOSPITAL DISTRICT ET AL. vs AGENCY FOR HEALTH CARE ADMINISTRATION  (2010)
Division of Administrative Hearings, Florida Filed: Jun. 01, 2010
The issues in the case are whether certain provisions of the Florida Medicaid Hospital Services Coverage and Limitations Handbook (Handbook) that exclude non-emergent services rendered in the emergency room from covered Medicaid outpatient services and require revenue Code 451 to be billed with CPT Code 99281 constitute an invalid exercise of delegated legislative authority within the meaning of Subsection 120.56(3), Florida Statutes (2010).1Amended as to the rules being challenged.
10-002997RU  BAPTIST HOSPITAL, INC.; BAY MEDICAL CENTER; HOLMES REGIONAL MEDICAL CENTER, INC.; LEE MEMORIAL HEALTH SYSTEM; LIFEMARK HOSPITALS OF FLORIDA, INC., D/B/A PALMETTO GENERAL HOSPITAL; MUNROE REGIONAL MEDICAL CENTER; NORTH BROWARD HOSPITAL DISTRICT, ET AL. vs AGENCY FOR HEALTH CARE ADMINISTRATION  (2010)
Division of Administrative Hearings, Florida Filed: Jun. 01, 2010
The issues in this case are whether the statement contained in Respondent's letter dated September 9, 1997 (1997 Letter), establishing a $24.00 payment for hospital outpatient services billed as revenue code 451 constitutes a rule as defined by Subsection 120.52(15), Florida Statutes (2010),1 and, if so, whether Respondent violated Subsection 120.54(1), Florida Statutes, by not adopting the statement in accordance with applicable rulemaking procedures.Statements in a 1997 letter constitute a rule and the statements were not promulgated as rules pursuant to Section 120.54, Florida Statutes.

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