Whether the Bay Regional and International Institute of Neurology/Dr. Radhakrishna Rao (Respondent) received Medicaid overpayments that the Agency for Health Care Administration, Office of Inspector General, Bureau of Medicaid Program Integrity (Petitioner), is entitled to recover, and whether a fine should be imposed against Respondent.Petitioner established that Respondent billings to Medicaid resulted in "overpayments."

Which certificate of need application seeking to establish a new 120-bed community nursing home in Nursing Home District 6, Subdistrict 5 (Polk County), on balance, best satisfies the statutory and rule criteria for approval: Lakeland Oaks NH, LLC’s CON Application No. 10309, or Eighth Florida Living Options, LLC’s CON Application No. 10303.On balance, under applicable criteria, the evidence showed that the CON application of the preliminarily-approved applicant should be approved for the establishment of a 120-bed nursing home in Polk County, Florida.

Which certificate of need application seeking to establish a new 120-bed community nursing home in Nursing Home District 6, Subdistrict 5 (Polk County), on balance, best satisfies the statutory and rule criteria for approval: Lakeland Oaks NH, LLC’s CON Application No. 10309, or Eighth Florida Living Options, LLC’s CON Application No. 10303.On balance, under applicable criteria, the evidence showed that the CON application of the preliminarily-approved applicant should be approved for the establishment of a 120-bed nursing home in Polk County, Florida.

Are the Medicaid payment claims of Respondent Alternative Care Staffing, Inc. (Alternative), for companion care services authorized by support plans and waiver support coordinators and provided in the community to recipients residing in group homes reimbursable services under the Home and Community-Based Wavier (HCB Waiver) program? Are Alternative’s Medicaid service claims for allegedly unauthorized activities reimbursable under the HCB Waiver program, or may the Agency for Health Care Administration (Agency) recoup payment for the claims? Did Alternative receive payment for services provided by ineligible staff? Are Alternative’s allegedly overlapping Medicaid service claims actually overlapping? Did the Agency meet: (1) its burden of proof for imposing fines, and (2) its statutory obligations before imposing fines? Whether or how much, due to mitigating factors, the Agency can fine Alternative for the items identified as overpayments in Agency’s Exhibit 6, Amended Final Audit Report dated May 25, 2011; subsequently, modified in Agency’s Exhibit 7, Current Overpayment Calculations and Agency Work Papers; and finally modified during the hearing as shown in Exhibit A to the proposed recommended orders and this Recommended Order.Agency proved provider didn't document experience requirements or appropriateness of services. Agency estopped from disallowing claims for companion services outside licensed home when services included in APD approved plans.

Whether Florida Administrative Code Rule 15A-9.006(2) (the Rule) is an invalid exercise of delegated legislative authority, pursuant to section 120.52(8)(b), (c), and (d), Florida Statutes.Rule 15A-9.006(2) is invalid execise of delegated leg authority because of lack of authority, enlarging of law implemented, and vesting unbridled discretion in agency. Mfr of ignition interlock device has standing to challenge rule reqg contracts.

Whether the Agency for Health Care Administration (Agency) is entitled to recover alleged Medicaid overpayments, sanctions, and investigative, legal and expert witness costs from Angels Unaware, Inc. (Respondent).The Agency for Health Care Administration presented evidence to support the overpayment to Respondent.

Whether Respondent, the Agency for Health Care Administration (AHCA or the agency), has any agency statements with regard to reimbursement of Medicaid expenses by physician providers for long-term electroencephalographic monitoring which are agency rules, as defined in section 120.52(16), Florida Statutes, but have not been adopted as rules in violation of section 120.54(1)(a), Florida Statutes, and if so, whether costs and attorney?s fees should be awarded.Medical standards applied by AHCA Medicaid peer reviewer during MPI audit of providers' records are not agency statements defined as rules. The standards do not alone create rights, require compliance, or otherwise have the force and effect of law.

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.

The principal issue in this case is whether an existing rule, which requires that, to become enrolled as a Florida Medicaid provider, a durable medical equipment supplier must establish and maintain a place of business either in Florida or within 50 miles of the state line, constitutes an invalid exercise of delegated legislative authority. A second issue, assuming the rule is not invalid for other reasons, is whether the rule impermissibly burdens interstate commerce in violation of the United States Constitution.Respondent`s existing rule, which requires that, to become enrolled as a Florida Medicaid provider, a durable medical equipment supplier must establish and maintain a place of business either in Florida or within 50 miles of the state line, is invalid.

Whether proposed amendments to Florida Administrative Code Rule 59G-8.200 are invalid exercises of delegated legislative authority.Portions of the waiver program handbook were invalid exercises of delegated legislative authority. The limitation of services for residential rehabilitation services, respite care, and adult day training were determined to be valid.