STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
CAROL'S CARE CENTER, )
)
Petitioner, )
)
vs. ) CASE NO. 82-1785
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
This case was heard pursuant to notice on October 28, 1982, in Deland, Florida, by Stephen F. Dean, assigned Hearing Officer of the Division of Administrative Hearings. This case arose upon the filing of audit exceptions by the Department of Health and Rehabilitative Services based upon its audit of Carol's Care Center's cost reports for 1978, 1979 and 1980. Carol's Care Center requested a hearing to determine the validity of the Department's exceptions.
APPEARANCES
For Petitioner: Karen L. Goldsmith, Esquire
Michael J. Bittman, Esquire Day Building, Suite 610 605 East Robinson Street Post Office Box 1980 Orlando, Florida 32802
For Respondent: Joseph L. Shields, Esquire
Office of Audit and Quality Control Services
Department of Health and Rehabilitative Services
1323 Winewood Boulevard
Tallahassee, Florida 32301 ISSUE
The issue in this matter is whether the Department's audit exceptions were valid.
Both parties submitted post-hearing proposed findings of fact in the form of a proposed recommended order. However, the Department's proposed recommended order contained no real findings. To the extent the proposed findings of fact have not been included in the factual findings in this order, they are specifically rejected as being irrelevant, not being based upon the most credible evidence, or not being a finding of fact.
FINDINGS OF FACT
General Background
At all times material hereto, Carol's Care Center (CCC) was a licensed nursing home facility certified to and participating in the Florida Medicaid Program. (Stip.)
At all times material hereto, Volusia County owned the facility, which was an indigent nursing home. The first wing of the facility was constructed in 1954, at a time when there were no building codes for Volusia County. Volusia County operated the nursing home until 1968, at which time the county leased the nursing home to Dr. George Erickson. Both Volusia County and Dr. Erickson suffered financial losses in the operation of the nursing home. (Tr. 43, 162)
In 1969, Carol E. Forrer and her son, Walter Littler, took over operation of the nursing home. Under their contract with Volusia County, the nursing home was required to accept up to 95 percent indigent patients. Another clause in that contract required the remaining five percent of the nursing home's beds to be available for Medicaid patients, if needed. Almost all of the nursing home patients were indigent. (Tr. 44, 162, 163)
CCC experienced serious and continuous financial problems prior to 1979 because of the number of indigent or Medicaid patients placed at CCC. Funds were always short. In addition, the building was antiquated and in such poor condition that it required at least six staff people on the payroll to do only maintenance work. The reputation of the facility was horrendous. In addition, staff was difficult to find and keep because of low pay and poor working conditions. In fact, turnover was 105 percent. In 1979, Mrs. Forrer had extreme difficulty in getting physicians and nurses to treat patients in the nursing home. In early 1979, the Department of Health and Rehabilitative Services (Department) informed Mrs. Forrer that the building was not in conformance with licensure standards and would not be allowed to continue operation as a nursing home. Mrs. Forrer knew that a new facility had to be built, but she could not finance the necessary expenses because the county owned the facility. (Tr. 45, 48, 162, 165)
In an effort to solve many of the problems at the nursing home, Mrs. Forrer hired Progressive Management Group (PMG) in July of 1979 to operate and administer the facility. Mrs. Forrer stayed on as administrator for August, 1979, during the transition period in which PMG took over. The Department disallowed $2,109 of her salary on the basis that there could not be two administrators. (Tr. 45, 46)
On December 31, 1979, CCC had 134 beds, and its occupancy rate was approximately 97 percent. Of the patients at CCC, 88 to 92 percent were Medicaid patients. When Charles F. Cantrell, Jr., purchased all of Mrs. Forrer's stock in the 344 Corporation and assumed responsibility for the operation of CCC, the nursing home had the highest Medicaid percentage in the area because local doctors were not referring private patients to the nursing home. Private patients generate revenues that can be used to offset expenses for Medicaid patients. (Tr. 50, 51, 52)
On December 31, 1979, Mr. Cantrell purchased Mrs. Forrer's stock and assumed any liabilities arising from the audits of CCC by the Department for the fiscal years 1978 and 1979. (Tr. 45, 70)
The Department conducted audits of CCC for the fiscal years ending August 31, 1978, 1979 and 1980. The audits for fiscal years 1978 and 1979 were conducted by Hugo Jordan, an auditor employed by the Department. The Medicaid Program is a joint federal and state program. It is governed by the Florida Title XIX Medicaid Reimbursement Plan and the applicable doctrines in HIM-15. The Medicaid cost reports for CCC in fiscal years 1978, 1979 and 1980 were timely filed. This dispute arose from audit adjustments to CCC's Medicaid cost reports for fiscal years 1978, 1979 and 1980. (Stip.; Tr. 289; Petitioner's Exhibits 4, 5, 6)
Activities of Charles F. Cantrell, Jr.
The Department notified CCC that it would not be relicensed in the absence of major alterations of the physical plant to bring it up to existing standards. This was impossible because of the state of the existing building. Cantrell negotiated an arrangement with the Department that CCC would continue to be licensed upon the condition that major intermediate repairs be made to the existing facility and a new facility be built within 30 months. (Tr. 49, 57, 151)
Cantrell was obliged to continue to operate CCC in the existing facility, making the necessary repairs to the physical plant, upgrading staffing and establishing an effective bookkeeping system while also undertaking to plan, finance and build a new facility. All of these actions were necessary to meet conditions for Department licensure and to continue operating the facility which was the primary facility in the area providing care for indigent and Medicaid patients. (Tr. 49, 57, 59, 151)
Cantrell took a direct hand in the management and operation of the facility. He assumed the business management of CCC, supervising and arranging for maintenance and repairs, revamping the bookkeeping system and training personnel, and coordinating activities related to the planning, financing, certification and building of the new facility. All of his activities were necessary.
Cantrell's prior experience as the owner of several businesses, including a small chain of drug stores, and his experience in providing professional services to nursing homes assisted him in keeping CCC operating and in establishing the new facility which is now in operation.
Cantrell was a salaried management employee of CCC for eight months in fiscal year 1980. He was paid $37,977 by CCC for his services. Under Department guidelines, the annual salary for the administrator of a facility the size of CCC was $27,032.
Cantrell dismissed PMG shortly after he took control on December 31, 1979. Because he was not a licensed administrator, Cantrell employed Mrs. Forrer for several weeks as an interim administrator. Cantrell hired Buford Jones as the permanent administrator in March, 1980. Jones is still in this position. Jones and Mrs. Forrer were assigned duties related to patient care, staffing and record-keeping related to patient care.
The Department audit disallowed one month of Cantrell's compensation in total because his service overlapped that of two other administrators. In addition, the Department reduced Cantrell's salary to that of an assistant administrator/owner. The total disallowed by the Department was $25,277.
The Department disallowed $1,195 of Mrs. Forrer's salary for the fiscal year ending August 31, 1980, on the same grounds.
The field auditor for the Department disallowed a portion of Mrs. Forrer's salary in fiscal year 1979, when PMG was employed, because of overlapping administrators. The Department's auditor took the position that there could not be two administrators at the same time.
The total salary paid Mrs. Forrer for the periods of transition in August of 1979 and January, 1980, when her employment overlapped that of another administrator, were legitimate. Both administrators were head administrators, one leaving and one coming. The maintenance of continuity and the benefits flowing to the patients warrant such a transition.
The auditor for CCC, Betty Kelly, C.P.A., gave her expert opinion, based upon her personal observation of Cantrell's activities and the duties he performed. Cantrell's activities were necessary, and, had he not performed them, someone would have had to be hired to do those jobs. The salary he received was reasonable and consistent with salaries paid other persons for similar work. The situation at CCC was unusual, and its many problems justified additional management, expertise and personnel. CCC needed more than an assistant manager. It needed a separate manager to handle business operations until its inherent problems could be solved. Cantrell provided this expertise.
Drug Expenses
In fiscal year 1978, the Department disallowed $1,894 in prescription drug expenses on the grounds that prescription drugs are not covered under the Florida Medicaid Program. (Petitioner's Exhibit 4)
In 1978, the Florida Medicaid drug program permitted patients to purchase $33 worth of legend drugs with a monthly Medicaid eligibility card. Some patients exceeded the limits on their card and had to apply for an excess prescribed medicine grant. In order to apply for the grant, the patient forwarded a form to the attending physician. (Tr. 84, 85, 86)
The drug information portion of the form was to be completed by the physician and submitted to Jacksonville or to Tallahassee, where a board of physicians would review the request. The physicians, in general, were unable or unwilling to fill out these forms because they could not obtain the needed information. As a pharmacist, Cantrell applied for 700 to 800 excess prescribed medicine grants, but only ten were approved for increases. (Tr. 86, 87)
Since some drugs are life-sustaining, CCC assumed the responsibility in fiscal year 1978 of paying the pharmacist for the excess cost of a Medicaid patient's prescription drugs. The amount of $1,894 represents the excess of purchases of drugs from The Medicine Shoppe. (Petitioner's Exhibit 16)
Nursing homes are responsible for supplying their patients with prescribed drugs.
Rental Equipment
In fiscal year 1978, the Department disallowed $2,444, which represented 100 percent of the costs of a leased automobile. In fiscal year 1979, the Department disallowed $2,270, which represented 100 percent of the costs of a leased automobile. (Petitioner's Exhibits 4, 5)
CCC operated three vehicles in 1978: a maintenance vehicle, a Pontiac Grand Prix, and a Dodge van. The maintenance vehicle was used to haul lumber and other items. The van contained a lift and was designed to transport patients. The van was used to transport patients until its insurance was raised to $3,600 per six months because of installation of the lift. It was thereafter not used to transport patients. The Pontiac was rented for that purpose, with insurance being included in the rental charges. Eventually, the maintenance vehicle was disposed of and the van used by maintenance personnel. (Tr. 169, 170, 176)
All three vehicles were kept at the facility, and they were all used for patient-related activities. The Pontiac was used to transport patients. Mr. Littler also used it to conduct nursing home business in Tallahassee and Jacksonville. Littler left his personal car at the facility whenever he took the Pontiac and did not charge the costs of this vehicle to the Medicaid program. (Tr. 72, 172)
Depreciation of Camper
The Department disallowed $295 in fiscal year 1978 for depreciation on a camper as not related to patient care. (Petitioner's Exhibit 4)
The camper in question was used by Dr. Legg, a scientist, while he was conducting studies related to the certificate of need for the new facility. (Tr. 178, 179)
Advertising and Promotion
In fiscal year 1978, the Department disallowed $210 on the grounds that it constituted promotional advertising. (Petitioner's Exhibit 4)
The amount contained in Petitioner's proposed recommended order exceeded the amount disallowed. None of the advertising was for the purpose of hiring staff. The aerial photograph was taken for use in settling a property dispute with the city. It was directly related to cost containment in operating the facility by reducing maintenance requirements and taxes. As such, this provided a benefit to the patients and to the public.
Utility Expense
In fiscal year 1978, the Department disallowed $272, claiming that this was for utility bills for a commercial building owned by Mr. Littler. (Tr. 196; Petitioner's Exhibit 4)
At said time, the Department cited CCC for not having proper beds. Littler used the building to refurbish beds for the facility according to the Department's standards. More than 100 beds were refurbished on the property owned by Littler.
The only demand Littler made in return for the use of his building was that CCC pay his utility bills during the period of time that the beds were being refurbished. (Tr. 197)
These utility bills paid by CCC were in actuality the rental assessed for use of the building. Considering the period of use, the rental was reasonable.
Additional Rents
The Department disallowed $2,000 in fiscal year 1978 for rent paid to Volusia County. (Tr. 198; Petitioner's Exhibit 4)
The records of CCC reflect that it paid $38,000 in rents to Volusia County in 1978. The contractual rental was $36,000 per year. The auditor concluded, based upon data which he believed was given him by a bookkeeper, that the $2,000 was a late payment of 1977 rents.
The uncontroverted testimony of Mr. Littler was to the contrary. Volusia County was to pay for repairs to the facility under the terms of the lease, but it did not have the money to pay for repairs required by the Department. It was agreed that CCC would pay Volusia County $2,000 for a sinking fund to cover future repairs. The $2,000 paid to this fund was not used to pay for repairs and was not for rental. The county retained it.
Gasoline Expense
In fiscal year 1980, the Department disallowed $380 of gasoline expense which was used in the vehicles of CCC's employees when they used their vehicles for patient-related activities. Petitioner is not challenging $133 of this adjustment. (Petitioner's Exhibits 6, 18)
CCC has one gasoline credit card that is kept by Mr. Jones to supply fuel to vehicles that are used in the service of the nursing home. (Tr. 108)
Jones only allowed other employees to use the gasoline credit card for patient-related activities. Cantrell never used the gasoline credit card for his own vehicle because he has another card. Employees who have used the gasoline credit card are the administrator, the activities director, the maintenance-man and the secretary. (Tr. 108, 109, 239)
The amount of $247 would be an expense related to operations of the facility.
Professional Services
In fiscal year 1980, the Department disallowed $1,061 as costs incurred in the prior year. (Petitioner's Exhibit 6)
The legitimacy of the expense is not at issue, and it was disallowed solely because it was not incurred in fiscal year 1980. These expenses were inadvertently omitted from the 1979 cost report. (Tr. 272; Petitioner's Exhibits 18, 19)
The expenses for the 1979 audit are also at issue in these proceedings.
Travel and Expense
The Department disallowed $821 in fiscal year 1978 because the expense was considered personal. Petitioner does not challenge $247 of this adjustment. (Petitioner's Exhibit 4)
A portion of this expense is related to the expenses incurred by Mr. Littler to go to Washington, D.C., to participate in what was primarily a lobbying effort. This was not for the benefit of the patients or to increase the professional skills of Littler.
Each administrator who is licensed by the State of Florida must attend a certain number of seminars every year as a condition of licensure. Mrs. Forrer and Littler registered and participated in the Miami seminar to expand their knowledge and to maintain their nursing home administrators' licenses.
Mr. Jordan admitted that he erred in disallowing $157 for Mrs. Forrer's hotel room on this trip. Littler's room expense for this trip was $170. No travel expense was validated. (Tr. 188, 189, 291)
Littler attended a seminar in Atlanta on cost reporting sponsored by the University of Pennsylvania. His American Express invoices contain a record of certain expenses which he incurred while attending this seminar. This was an activity related to Littler's professional qualification and to the business operations of CCC. The travel and room expense were $206. (Tr. 191; Petitioner's Exhibit 14)
Mrs. Forrer's and Littler's expenses for the trips to Miami and Atlanta are $533.
Other exhibits include expenses not mentioned in Petitioner's proposed recommended order. It is assumed that the Petitioner has abandoned those claims, and no findings are made regarding them.
Travel and Expense
In fiscal year 1979, the Department disallowed $113 as an expense that was not actually spent in that year. Petitioner asserts that the $113 was refunded in 1980, and the 1980 expenses reduced by that amount. This is based upon the testimony of the facility's accountant at pages 275 and 276. The effect of the accounting treatment was to reduce the 1980 expenses by $113. The result is that the Department deducted the $113 in 1979, and the accountant deducted the $113 again in 1980.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction to hear this cause and enter this Recommended Order pursuant to Section 120.57(1), Florida Statutes. The Department of Health and Rehabilitative Services is charged with regulation of public medical assistance pursuant to Chapter 409, Florida Statutes.
Salary of Cantrell
The Department disallowed $25,277 of the $37,977 salary paid to Cantrell by CCC as excessive salary for an owner/operator. A portion of the disallowance is justified, however, the amount is too great. The Department used as Cantrell's appropriate base salary that of an assistant administrator. The Department determined that the facility could not have two administrators. No authority for this determination is cited.
In this case, the situation at CCC was so critical that two chief administrators were justified. The facts show that all areas of operation had significant problems. Cantrell's intervention prevented the probable closure of
the facility, which would have been detrimental to the public interest. Cantrell hired a licensed nursing home administrator to administer the areas of patient care, health care staff and patient records. Cantrell assumed primary responsibility for maintenance, repairs, housekeeping, business management, business staff training, and interaction with the Department. Therefore, the critical situation warranted extra management expertise provided by two chief administrators, and the appropriate base salary should have been $18,020 to
$27,032. The same circumstances plus Cantrell's management background warrants the highest figure, $27,032 per annum.
Cantrell worked eight months and should have been entitled to $18,021. This figure would normally be adjusted to a degree because some of his time would be deemed to be looking after his investment. However, the facility's accountant testified that had Cantrell not undertaken to assist her with the audit and to train the bookkeepers, additional personnel would have had to be hired or additional professional expense would have been incurred. Therefore, this is treated as an offset against the reduction to the owner/administrator's salary and considered of equal value. The adjustment would be $37,997 less
$18,021, or $19,956.
Salary of Forrer
The Department disallowed $1,915 of Mrs. Forrer's salary for the fiscal year ending August 31, 1980. Mrs. Forrer was employed as an interim administrator between the time PMG ceased to manage the facility and the time Buford Jones was hired. The $1,915 of her salary was disallowed under Section 907.1, HIM-15. There is no further clarification of the reason her salary was disallowed beyond the testimony of the auditor, who stated he took the view that there could not be two legitimate administrators.
A careful review of Section 904.1, HIM-15, reveals no specific prohibition against multiple administrators. It states a number of factors that are involved in the determination of comparable salaries for an administrator. It does not speak to the question of more than one administrator, particularly during changes of administration. As stated above, the situation at CCC justified, additional management skills and their attendant costs. The expense for Mrs. Forrer's salary as interim administrator in 1980 is justified.
The Department also disallowed $2,109 for Mrs. Forrer's compensation in 1979, for the period in which she was paid her salary between July 4, 1979, and August 31, 1979, during which time PMG was assuming responsibility for the facility. The basis for the disallowance of this salary expense is the same as that cited above. Again, PMG was employed because of the significant problems CCC had. A period of transition is not prohibited by HIM-15, which is silent on this subject. It is concluded in this case that a period of less than two months is not unreasonable and is beneficial to the patients.
Drug Expense
The Department has determined that nursing homes are responsible for supplying medications to patients, and has also determined that the cost in excess of $33 per month per patient must be submitted through application for an excess prescription medicine grant. A procedure exists for applying for these grants.
Few of these grants are approved; however, this does not relieve the facility of the obligation to provide the medications. These costs are generally absorbed by facilities by additional charges to private patients. However, CCC had few, if any, such patients. If, as with CCC, a facility lacks private patients, the facility has no means of recapturing this expense. The evidence in this proceeding pinpoints the conflicting provisions of Department rules regarding drug reimbursement as an area for study by the Department's administrators. However, as it now stands, the Department has correctly applied its existing rules and regulation. These charges must be denied.
Rental Equipment
The Department disallowed the cost of leasing a Pontiac Grand Prix in 1978 and 1979, for a total of $4,714. The primary basis for disallowance was that CCC had a van equipped with a lift for patient use, and no log of the Pontiac's use was available. The evidence revealed that when the van's lift was installed the insurance for this vehicle became so great that it was not used for patients. It was cheaper to rent a car for patient use because insurance for that car was included in the rental costs. The evidence also shows that the vehicle was maintained at the facility, not taken home by the administrators, and used only to transport patients and for business travel. HIM-15 does not require a log to be kept on a vehicle used solely for business purposes. The total cost of the rental is allowable.
Depreciation of the Camper
The Department disallowed $295 for depreciation of a camper used by Dr. Legg in doing work for the certificate of need for the new facility. This expense is not allowable. At best, it is cost of establishing the new facility, not of operation of the old facility.
Advertising and Promotion
The Department disallowed a total of $210 for advertising cost. This included radio and newspaper advertisements and the cost of an aerial photograph. The record shows that the advertising on radio and in newspapers was not for staff. HIM-15 disallows advertising for other than staff.
The record shows that the aerial photograph was taken as part of an effort to resolve a conflict over taxes and maintenance of grounds between the county and CCC. This dispute was resolved favorably for CCC. The cost of the aerial photograph is an allowable professional expense.
Utility Expense
The Department disallowed $272 of cost related to utility bills for a commercial building owned by Mr. Littler. Said building was used to store beds from CCC while the beds were modified to meet Department criteria. Littler agreed to permit the beds to be stored there on the basis that CCC pay the utility bills on the building during said period. This constitutes a payment by CCC for the use of the building, which is a rental. The use of the building was related to the maintenance of equipment used by CCC. This is an allowable rental expense.
Additional Rents Paid Volusia County
The Department disallowed $2,000 in 1978, as rental paid in 1978 but due in 1977. There was controverted testimony concerning what the payment was. A bookkeeper told the auditor it was for 1977 rents. Mr. Littler testified it was a payment to a sinking fund established by the county to pay for major repairs at the facility. Littler also testified that the county never used this money to pay for any repairs at the facility. As such, it was neither a rental cost nor a repair cost, and was not required under the lease. It does not meet any criteria of a reimbursable expense and is properly disallowed.
Gasoline Expense
The Department disallowed $380 of expense for a gasoline credit card, citing Section 2102.2, HIM-15. Petitioner does not controvert $133 of the amount disallowed. The record reflects that this was used for gasoline used in employees' vehicles when they were used to transport patients. Control of the card's use was by the administrator, Jones, and the only persons who used the card were Jones, the activities director, the maintenance man and a secretary. In the absence of evidence to the contrary, $247 is a patient-related expense and allowable.
Professional Services
The Department disallowed $1,061 for professional services. The sole ground for denial of this cost is the fact that it was accrued in the year before it was claimed after having been inadvertently deleted from the prior year's cost. The prior year's cost is also under review in these proceedings.
It is unclear whether the rules provide for amendment of prior year's cost figures; however, an amendment process is assumed to exist. The appropriate method to raise this initially would have been to file an amendment. However, at this point, administrative economy would indicate that in the absence of any other grounds to challenge the reimbursement, it should be allowed for the preceeding year.
Travel and Expense
The Department disallowed $821 in travel expense in 1978. Petitioner does not controvert $247 of this adjustment. The record reflects that a portion of this expense was related to a trip by Mr. Littler to Washington, D.C., primarily in a lobbying effort. As such, it is not allowable.
Part of the expense is related to a trip by Mrs. Forrer and Littler to Miami, Florida, for a seminar on nursing home administration. Both Mrs. Forrer and Littler are required to meet continuing education requirements for licensure. This is an allowable expense where it is reasonable. The travel expenses and room expenses are allowable. The cost of the food is not reasonable and is therefore disallowable.
Part of the expense is attributable to a trip by Littler to Atlanta to attend a seminar on nursing home cost reporting. Similarly, this is a legitimate expense, and his travel and room expense is allowable. The total allowable travel expense is $533.
Travel and Expense
The Department disallowed $113 of travel expense in 1979. Petitioner does not controvert the deduction but asserts that the $113 was reimbursed in 1980, whereupon the accountant for the facility reduced the facility's expenses by $113. This evidence was uncontroverted. The effect is to reduce the facility's expenses by $113 in both 1979 and 1980. The proper procedure would be to amend the 1980 report; however, in the absence of any specific grounds for denying this adjustment, it would conserve administrative effort to permit this expense upon the evidence adduced at hearing.
Based on the foregoing Findings of Fact and Conclusions of Law, the following is recommended:
The adjustment to Cantrell's salary should be reduced from $25,277 to
$19,956;
The adjustment to Mrs. Forrer's salary of $1,915 in 1979, and of $2,109 in 1980, should be rescinded;
The adjustment for drug expenses of $1,894 should not be altered;
The adjustment of $4,714 for rental of a Pontiac Grand Prix in 1978 and 1979 should be rescinded;
The adjustment of $295 for depreciation of the camper should not be altered;
The adjustment of $210 for advertisements should be reduced by $125, the cost of the aerial photograph;
The adjustment of $272 for utility expense should be rescinded;
The adjustment of $2,000 for rentals should not be altered;
The adjustment of $380 for gasoline expense should be reduced by $247;
The adjustment of $1,061 for professional services should be rescinded unless other grounds exist to deny an amendment of the previous year's report;
The adjustment of $821 for travel and expense should be reduced by
$533; and
The adjustment of $113 for travel in 1979 should be rescinded unless other grounds exist to deny an amendment of the previous year's report.
DONE and RECOMMENDED this 16th day of February, 1983, in Tallahassee, Leon County, Florida.
STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 16th day of February, 1983.
COPIES FURNISHED:
Karen L. Goldsmith, Esquire Michael J. Bittman, Esquire Day Building, Suite 610
605 East Robinson Street Post Office Box 1980 Orlando, Florida 32802
Joseph L. Shields, Esquire Office of Audit and Quality
Control Services Department of HRS
1323 Winewood Boulevard
Tallahassee, Florida 32301
David H. Pingree, Secretary Department of HRS
1323 Winewood Boulevard
Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| Feb. 16, 1983 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Feb. 16, 1983 | Recommended Order | Detailed discussion of costs allowed and disallowed in nursing home Medicare audit. |
