STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
HERBERT TOPOL, D.O., )
)
Petitioner, )
)
vs. ) Case No. 85-0764
) STATE OF FLORIDA, DEPARTMENT OF ) HEALTH AND REHABILITATIVE )
SERVICES, )
)
Respondent. )
) SYLVAN GOLDIN, D.O., )
)
Petitioner, )
)
vs. ) Case No. 85-0765
) STATE OF FLORIDA, DEPARTMENT OF ) HEALTH AND REHABILITATIVE )
SERVICES, )
)
Respondent. )
) TOPOL-GOLDIN GENERAL PRACTICE, )
)
Petitioner, )
)
vs. ) Case No. 85-0766
) STATE OF FLORIDA, DEPARTMENT OF ) HEALTH AND REHABILITATIVE )
SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, a formal hearing was held in these cases on April 28-30, 1986, in Ft. Lauderdale, Florida, before the Division of Administrative Hearings by its designated Hearing Officer, Diane R. Kiesling.
APPEARANCES
For Petitioner Herbert Topol, D.O., pro se Topol: 1111 West Broward Boulevard.
Fort Lauderdale, Florida 33312
For Petitioner Sylvan Goldin, D.O., pro se Goldin: 1111 West Broward Boulevard
Fort Lauderdale, Florida 33312
For Petitioner Sylvan Goldin, D.O., pro se Topol-Goldin: 1111 West Broward Boulevard
Fort Lauderdale, Florida 33312
For Respondent: Theodore E. Mack, Esquire
Assistant General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Boulevard Building One, Suite 407 Tallahassee, Florida 32301
ISSUE
The issue in these cases is whether Petitioners are entitled to the Medicaid payments which they received or whether the claims filed by Petitioners were improper.
At hearing Petitioners presented the testimony of Gary Allen Kitos; Joseph Namey, D.O.: Herbert Moselli; Robert Grenitz, M.D.; Mary Bone; Herbert Topol, D.O.; Sylvan Goldin, D.O.; and Mildred Martin. Topol Exhibits 1-3 and 5 were admitted in evidence. Goldin Exhibits 1-4, 6 and 7 were admitted in evidence. Topol-Goldin General Practice (GP) Exhibits 1-7 and 35-37 were admitted in evidence. The Department of Health and
Rehabilitative Services (HRS) presented the testimony of Jules J. Cohen, D.O.; Morton T. Smith, D.O.; and Mildred Martin. HRS also presented the testimony by deposition of Lawrence E. Stivers and Michael W. Forsthoefel, M.D. HRS Exhibits 1-23 were admitted in evidence. Joint Exhibits 1-4 were also admitted, which include three inventory lists and four separate large boxes of patient records.
The parties filed proposed findings of fact and conclusions of law. All proposed findings of fact and conclusions of law have been considered. A ruling has been made on each proposed finding of fact in the Appendix hereto and made a part hereof.
FINDINGS OF FACT
During 1932, Petitioners Goldin, Topol, and the Topol- Goldin General Practice Clinic were all operating out of the same facility but each billed Medicaid under a separate physician provider number.
Medicaid is a joint state and federal program that is completely voluntary.
In entering into a provider agreement with Medicaid, Topol, Goldin and the General Practice Clinic agreed to abide by the provisions of the Florida Administrative Rules, Florida Statutes, policies, procedures, manuals of the Florida Medicaid Program and federal laws and regulations.
Under the Medicaid Program, a state may limit the services provided for under federal regulations.
As part of the requirements for participation in Medicaid, the State of Florida has a peer review process to monitor all providers.
Peer review is a recognized process utilized by third party payors (such as Medicaid, Medicare and insurance companies) to assure that they are getting the services for which they are paying.
Florida's Medicaid peer review process is modeled after the federal Medicare Program's process.
In Florida approximately 7,000 physicians are enrolled in the Medicaid program at any one time.
In order to monitor all of these physicians' practices, the Medicaid Program reviews those physicians whose practice exceeds the parameters of the average Medicaid physician's practice.
Reviews of physicians' practices number between 60 to
85 physicians per year.
Approximately 40-50% of those physicians reviewed are referred for peer review.
The Medicaid review for physicians consists of a Level I review of the physician's activity in the program compared to the physician's peers.
If the physician exceeds the upper limits in the Level I review, a desk review is done by medical consultants who review a "claims detail" of all claims for payment made by the provider.
If further review is needed, a disproportionate stratified random sample (DSRS) of the physician's claims is obtained and the physician's patient records for those claims are obtained.
The physician's records are first reviewed by a Medicaid physician consultant who determines if peer review is necessary.
After a peer review is done, an in-house consultant does a line-by-line evaluation based on the peer review findings and medical necessity and makes a recommendation for denial of claims.
Those claims denied are then converted into an amount of money for disallowance.
The Medicaid program does not review physicians just because of the amount of money they make in the program.
In September of 1981 the Medicaid Investigative Section requested updates on providers who had previously been investigated in 1977. Goldin, Topol, and the General Practice Clinic were among those providers.
Cases for review were then opened for Goldin, Topol, and the General Practice-Clinic in 1982.
A preliminary cursory review of the practices of Goldin, Topol, and the General Practice Clinic was prepared by a nursing consultant who recommended that the investigation go forward.
During the same time period that the review of Goldin, Topol, and the General Practice Clinic was beginning, a separate review of a Medicaid recipient raised questions of pingponging (going from one doctor to another) between Drs. Topol and Goldin that would justify a further review of their practice.
In February and March of 1983, Level II Review reports (desk analysis) were issued on Goldin, Topol, and the General Practice Clinic. These reports contained the Level I Reviews, documentation of the provider's 1982 Medicaid practice, complaints, conclusions, and recommendations.
The Level I Review reports included in the Level II Review indicated those areas where the providers exceeded the upper limits of their peers. For example, Dr. Goldin averaged 1,998 Medicaid office visits per quarter compared to an average of 86 for other Medicaid physicians. Dr. Goldin's average exceeded two standard deviations above the average for his peers.
The Level II Reviews concluded that the allegations of overutilization for Goldin, Topol, and the General Practice Clinic had been substantiated and it was recommended that they be referred to Peer Review.
In March of 1983, a meeting was held to discuss these cases because of their complicated nature. At that meeting, Mildred Martin was instructed to proceed with Peer Review
In preparing for Peer Review, disproportionate stratified random samples (DHRS) for Goldin, Topol, and the General Practice Clinic were obtained.
A DSRS is the tabulation of the provider's activities or the amounts paid to him for each recipient during a specific period of time. It lists the recipients in ascending order of amounts paid to the provider. Total amounts of the payments made during the period are divided into five strata of the same or close to the same amounts of money.
A DSRS is used to give an overall view of the physician's practice.
On each DSRS the computer randomly picked 30 patients for a detailed review of their patient records.
Because of the volume of practice of Goldin, Topol, and the General Practice Clinic, it would not have been fair to evaluate their entire practice using only 30 records. Therefore, HRS decided to review 7% of records of Topol and Goldin. The General Practice Clinic records were reviewed as randomly selected by the computer.
In order to enlarge the sample to 7%, Ms. Martin utilized a random selection process employed by Medicare, which entailed selecting every third patient beginning from the bottom of each strata and working up until a 7% sample was achieved. This does mean that patients in the 7% samples represent the patients in each strata for whom the highest claims were made.
When the same patient record appeared in two different samples, the next patient on the list was used to avoid duplication and disallowance of two of the providers for the same patient.
The records selected for review were selected randomly and selected utilizing generally accepted statistical techniques.
In June of 1983, Goldin, Topol, and the General Practice Clinic were requested to submit the records of those claims selected from the DSRS and the 7% sample process.
When it was obvious that the records received were not complete, Ms. Martin contacted the offices of Goldin, Topol and the General Practice Clinic, requesting the missing records.
Those records received from Goldin, Topol, and the General Practice Clinic were referred to the Florida Osteopathic Medical Association's (FOMA) Peer Review Committee along with information indicating the areas of concern and a letter of explanation from Dr. Goldin.
The FOMA Peer Review Committee is an independent organization made up of approximately ten osteopathic physicians from various parts of the State of Florida. The FOMA contracts with third party carriers (Medicaid) to review peers.
The cases supplied to the FOMA Peer Review Committee are reviewed and discussed and the committee issues its opinion on overutilization.
The FOMA Peer Review Committee's findings are either no overutilization, minimal overutilization (5-20%) overutilization), moderate overutilization (20-50%) or excessive overutilization (over 50%).
Upon receipt of the referral from HRS, the FOMA Peer Review Committee set up a meeting and invited Drs. Topol and Goldin. At that meeting held April 28, 1984, eight (8) physicians of the Peer Review Committee reviewed the charts and interviewed Drs. Topol and Goldin.
The Peer Review Committee looked for a trend in the physicians' overall practice.
The Peer Review Committee found that the records were poorly documented and difficult to read.
The Peer Review Committee found that the patients were being seen more than medically necessary.
It was a consensus of the members of the FOMA Peer Review Committee that there was moderate overutilization.
By letters dated May 9, 1984, the FOMA Peer Review Committee notified Drs. Topol and Goldin and HRS of their findings.
The medical records of Topo1 and Goldin were then sent to Dr. Michael Forsthoefel, M.D., for a line-by-line disallowance of services based upon the Medicaid rules and regulations and the Peer Review Committee's findings.
Dr. Forsthoefel disallowed an amount of claims in the range of 30-35% which fell within the level of moderate
overutilization (20-50%) determined by the Peer Review Committee, however, since Dr. Forsthoefel was an M.D. and not a D.O., HRS decided that in all fairness the determinations should be made by a D.O. who was a peer of the doctors being reviewed.
The medical records of Topol and Goldin under review were-then sent to Dr. Morton T. Smith, D.O., for the line-by- line determination.
In order to assure further fairness of the review, Dr. Smith was instructed not to review and disallow any claims by a physician that appeared on a record of the other physician being reviewed.
As a result of the new review by Dr. Smith and the instructions given him, the total amount disallowed dropped to 16 or 17%. (The Transcript, p. 635, says 60-70%, but that is a typographical error and should read 16-17%).
It is found that the peer review and the disallowances by Dr. Smith were reasonable and accurate.
It was then necessary to apply the amount disallowed in the 7% sample to the overall Medicaid claims of Topol and Goldin. HRS performed this calculation by determining the average overpayment for the recipients in each strata sample and multiplying that average by the total number of recipients in each strata. However, because the samples were selected from those recipients in each strata with the highest claims (See Finding of Fact 32), the "average overpayment per recipient" method of extending the overpayments in each sample to the total population of claims is arbitrarily skewed. The result is that Topol and Goldin were exposed to liability greatly in excess of the total amount claimed.
The more reasonable method for extending the overpayments in each sample to the total population of claims would be to determine the percentage of disallowed claims in each strata sample and to apply that percentage to the total paid in each strata. For example for Dr. Goldin in Strata I a total of
$922 was paid and $30 was disallowed, or a 3.25% disallowance. Applied to the total paid in that strata of $21,600.28, a total overpayment for Strata I is shown to be $702.01.
Using this method of calculation, it is determined that Dr. Goldin has been overpaid as follows:
Strata I | $702.01 | (30/922 X 21,600.28) |
Strata II | $2,957.64 | (204/1490.92 X 21,620.18) |
Strata III | $2,238.49 | (274.24/2378.94 X 21,627.92) |
Strata IV | $3,506.92 | (617.95/3805.88 X 21,594.33) |
Strata V | $5,886.05 | (1841.36/6729.80 X 21,513.33) |
Total | $15,291.11 |
Using this method of calculation, it is determined that Dr. Topol has been overpaid as follows:
Strata I | $1,417.87 | (60.98/728.16 X 16,939.88) |
Strata II | $2,263.31 | (160.00/1199.63 X 16,966.34) |
Strata III | $2,099.45 | (225.74/1823.52 X 16,958.37) |
Strata IV | $2,335.17 | (402.96/2935.57 X 17,007.75) |
Strata V | $4,195.75 | (1358.14/5443.97 X 16,816.65) |
Total | $12,311.55 |
The General Practice Clinic was treated differently because it was operated differently.
The provider number issued to the General Practice Clinic was applied for and granted to Drs. Topol and Goldin as authorized agents.
General Practice Clinic was actually operated and run by Mary Petruff Bone.
At the General Practice Clinic, Ms. Bone prescribed and mixed antigens for allergy patients, determined what testings were to be done, and handled other medical problems of patients. Neither Dr. Topol nor Dr. Goldin had any expertise in the field of allergy treatment.
The records of the General Practice Clinic were the responsibility and the product of Ms. Bone.
At all times material hereto, Ms. Bone was a certified physician's assistant competent to provide services to allergy patients.
A physician's assistant is not a physician.
At all times material hereto, physicians' assistants could not receive a provider number from Medicaid under which they could bill the Medicaid Program.
Ms. Bone billed Medicaid for her services under the General-Practice Clinic's physician provider number.
Medicaid was billed for physician's services by the General Practice Clinic even though a physician did not see the patient.
It is not usual and customary practice for physicians to bill for their services when they do not see the patients.
The State of Florida's Medicaid Program does not authorize payment for services to a physician's assistant under the supervision of a physician.
The Medicaid program paid $75,654.73 to the General Practice Clinic in 1982 under its physician provider number.
Medicaid did not learn that the General Practice Clinic's billings were for non-physician's services until the Peer Review Committee met with Petitioners on April 28, 1984.
For the General Practice Clinic, Dr. Goldin admitted that $40,642.85 should have been disallowed due to improper billing procedures.
The $40,642.85 calculated by Dr. Goldin did not take into account any possible double billing or the fact that the clinic's services were performed by a physician's assistant.
The records for the General Practice Clinic were not referred to a physician consultant because the payment denials were due strictly to noncompliance with Medicaid rules and regulations, not the overutilization findings of the Peer Review Committee.
Medicaid claims for the General Practice Clinic were denied for four basic reasons: 1) No records provided to substantiate the claim; 2) improper billing for B-12 injections;
3) duplicate billing where the General Practice Clinic and Topo or Goldin billed on the same day; and 4) office visits not rendered by a physician.
Antigen injections and allergy testing were not disallowed in the claims submitted by the General Practice Clinic because those services are commonly reimbursable when done by someone other than a physician under a physician's supervision.
The amounts disallowed for the sample of claims for the General Practice Clinic was then applied to the overall clinic practice in the same manner that the Topol and Goldin amounts were applied to their practice in order to obtain an amount owed the HRS Medicaid Program for the disallowed services. However, again the method used by HRS to extend the overpayment amount determined from the sample to the total population of claims is unreasonable because it does not accurately project the total amount overpaid. For example, in Strata I for the General Practice Clinic, a total of $15,177.73 in Medicaid benefits were paid in 1982. Yet, using the HRS method, a total overpayment of
$22,201.44 is determined for that strata, or $7,023.71 more than was ever paid in that strata. Such a result must be unreasonable.
If instead the percentage method applied above is used, it is determined that the General Practice Clinic has been overpaid as follows:
Strata I | $12,659.76 | (362/434 | X 15,177.73) |
Strata II | $12,784.78 | (1447/1719 | X 15,188.00) |
Strata III | $12,578.68 | (3284/4001 | X 15,325.00) |
Strata IV | $13,102.67 | (4244/4969 | X 15,341.00) |
Strata V | $12,215.79 | (5369/6427 | X 14,623.00) |
Total | S63,341.68 |
Some disallowances were made on all three provider numbers because no documentation was provided, even after Ms. Martin asked a second time. These disallowances are proper and correct because Medicaid will not pay for services where there is no documentation justifying the services. The fact that Petitioners now claim to have that documentation is irrelevant to the correctness of the disallowances.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction of the parties to and the subject matter of these proceedings. Section 120.57(1), Florida Statutes.
The Department of Health and Rehabilitative Services has jurisdiction to administer Medicaid funds pursuant to Section 409.266, Florida Statutes.
Pursuant to Rule 10C-7.38, F.A.C., Medicaid reimbursable physicians' services are defined as those "medically necessary procedures provided in the course of diagnosis and treatment of an illness or injury. In order to qualify for Medicaid reimbursement the physician is required to keep accurate medical records which fully disclose the extent of the service. 10C-7.38(11).
Rule 10C-7.30(7), F.A.C., provides:
(7) Services or goods billed to the Medicaid program must be necessary, Medicaid compensable and of a quality comparable to those furnished by the provider's peers, and the services or goods must have been actually provided to eligible Medicaid recipients by providers prior to submitting a claim. Any payment made by Medicaid for services or goods not furnished in accordance with these provisions is subject to recoupment and the Department reserves the right in such instances to initiate other appropriate administrative or legal action.
In addition, Rule 10C-7.60(1) and (10) state:
(1) Each provider of health care and related services who voluntarily enrolls in the Florida Medicaid Program shall agree to deliver services in accord with applicable State and Federal laws and regulations related to the Program and to the provider's professional services.
(10) Whenever it becomes apparent that any Medicaid provider has received any benefits under this Rule to which he is not entitled, either through simple mistake or fraud, the Department shall take all necessary steps to recover the overpayment, unless it is determined that extreme hardship would result if repayment were forced at that time.
Such recoupment actions taken for alleged overpayment are the basis for this action.
Rule 10C-7.61, F.A.C., governs the manner in which HRS will determine overpayments to Medicaid providers. In this case HRS is seeking recoupment for overpayments of inappropriate or medically unnecessary treatment as authorized by 10C-7.61(2)(b)1 and 2.
In detecting the overpayments, HRS has complied with 10C-6.61(3)(a) which states:
(3) Detection of Possible Overpayments
Unusual Billing Patterns. Possible overpayments may be indicated by unusual billing patterns detected through the statistical analysis of claims submitted by a group of providers of a given type. The claims of a provider whose billings to the Medicaid Program appear to be unusual may be referred for additional review by the Medicaid Office.
Because the petitioners' practice was so large, HRS properly utilized a statistical method review pursuant to 10C- 7.61(4)(6) which allows for a representative sample to be taken and states:
Statistical Calculation. If it is not reasonably possible to examine every paid claim of a provider for a given period of
time in order to compare the amount actually paid with the amount that should have been paid, generally accepted statistical methods may be employed to determine the overpayment for the total population of claims. The total number of provider's claims of a specific type or types paid by Medicaid during a given period of time, will be taken to be the population of claims analyzed.
From this population of claims, or appropriate subset of the population, a statistically representative sample will be taken. The overpayment applying to the total population of claims, or subset of the population, will be calculated.
HRS generally followed this method of calculation, however, it has been found that the method used to calculate the overpayment applying to the total population of claims was not reasonable. The calculations using percentage made in the Findings of Fact represent a more reasonable method for calculating the overpayment applying to the total population of claims. Since the rule does not specify a specific calculation methodology, it is concluded that the percentage method set forth in the Findings of Fact is the appropriate method in the instant cases.
In determining overutilization, HRS properly applied 10C-7.61(4)(c) which states:
Peer Review. When conducted, peer review will be carried out by peers of the provider. These persons shall be members of an organization whose purposes include peer review, or they shall be professional consultants to the Department who are peers of the provider. Peer review is conducted in order to determine the appropriateness, necessity or quality of the goods or services furnished by the provider under review and paid for by Medicaid. Those conducting the peer review shall examine either arbitrarily selected paid claims or a statistically representative sample of the paid claims, and related medical records, of the provider under review. The paid claims shall be either those paid by Medicaid during a given time period or those paid for services rendered by the provider during a given time period. Based on peer judgment and
evaluations, claims for inappropriate, unnecessary or inferior quality goods or services will be identified, and payments made for such goods or services will be considered to be overpayments. If arbitrarily selected paid claims have been examined, the total overpayment will relate only to those claims. If a statistically representative sample of claims has been examined, the overpayment applying to the sample will be extended to the total population of claims of the provider for the time period under review, using generally accepted statistical methods.
Pursuant to this rule the peer review in the instant case was properly conducted by the members of the Florida Osteopathic Medical Association's Peer Review Committee whose only purposes peer review. The members of that committee were peers of the providers and they determined that the petitioners' charts were poorly documented and difficult to read. They also determined that the petitioners' practice showed moderate overutilization of office visits.
Based upon the determination of the peer review committee, a medical consultant contracting with the Medicaid Program identified claims by Topol and Goldin for inappropriate or unnecessary services. The payments for such services were properly considered to be overpayments. That amount, extended to the total population of claims by the percentage method discussed above provides the total figure for overpayments to Topol and Goldin. The total amount owed by Dr. Topol is properly calculated to be $12,311.55. The total amount owed by Dr.
Goldin is properly calculated to be $15,291.11. When these figures are compared with the overall Medicaid payments to these doctors in 1982, which were $84,689 and $107,956.04 respectively, the total recoupment sought for each of the doctors is less than 20% of their Medicaid practice. This is below the moderate overutilization determined by the Peer Review Committee which can be anywhere from 20-50%.
Because it was determined at the Peer Review Committee meeting that the services billed for by the General Practice Clinic were not actually those services of Drs. Topol and Goldin, HRS did not review those files for overutilization in the same manner as it did for each doctor's practice. Instead, the services billed were denied as overpayment based upon specific rules, regulations, and billing guidelines established by HRS in accordance with federal regulations. Specifically, HRS denied those claims which were billed twice for the same service on the
same day under both the clinic's provider number and the provider number of either Dr. Topol or Dr. Goldin. Such payments were amounts greater than the single payment to which the provider was entitled and are therefore overpayments pursuant to Rule lOC HRS denied those claims for which the clinic provided no records to substantiate the billings in accordance with Rule lOC-7.38~11), F.A.C., and Rule lOC-7.61(2)(b)1., F.A.C. Third, HRS denied those claims for s-12 injections which were disallowed by the Peer Review Committee and acknowledged by Drs. Topol and Goldin as inappropriate treatment for billing purposes. Finally, HRS disallowed all of those claims from the clinic for services which were provided by a physician's assistant and not Drs. Topol and Goldin. Such claims were appropriately disallowed in accordance with Rule lOC-7.61(2)(b)1., F.A.C., Rule lOC-7.38(1)(a)1., F.A.C.
and Sections 1-15, 2-6 and 2-5 of the 1981 HRS Physician Services
Medicaid Manual (Joint Exhibit 4).
Petitioners rely upon 42 CFR 440.50 and Section 1-4 of the Physician Services Manual to support their contention that physician services also encompass services "under the supervision of an . . . osteopath." Petitioners' reliance upon this wording is misplaced, however, since Section 1-4 is merely a general restatement of federal rules and goes on to state:
Each group in the service categories has special policy requirements and limitations that apply and must be met before payment can be made. Some of the requirements are established by the governing Federal regulations while others are specified by the Medicaid Program of Florida. A detailed description of policy and limitations in payment by service area is provided in the following chapters of this manual.
Therefore, those sections that specifically address physician services are controlling when determining if payment is allowed. In this case, Sections 1-15, 2-6 and 2-25 of the Physician Services Manual specifically indicate that physician services are limited to the services performed by the physician.
Section 1-15 defines physician services as:
Medical care rendered by a doctor of medicine or osteopathy, licensed to practice in the state where the service is provided, and provided within the scope of the practice of medicine or osteopathy as defined by State law; and
Section 2-6 regarding payment for office visits states:
Office visits are services performed by a physician in his or her own office or in an outpatient facility of a hospital, such as an outpatient clinic, examining or treatment room.
Section 2-25 regarding allergy studies states:
Allergy study services are based on testing and must include physician observation and interpretation of their significance in relation to the history and physical examination of the patient.
Clearly the disallowed services provided by the physician's assistant in the General Practice Clinic did not meet these requirements. Those services performed in the General Practice Clinic which were allowed by HRS consisted of the providing of allergy antigens which are specifically allowed to be billed under the physician's supervision by Procedure Code 95135 of Section 2-25 of the Physician Services Manual.
Again, the overpayments to the General Practice Clinic were determined from a sample and must be extended to the total population of claims. Using the percentage method for this calculation, it is concluded that the General Practice Clinic was overpaid by $63,341.68.
Based on the foregoing Findings of Fact and Conclusions of Law, it is
RECOMMENDED that the Department of Health and Rehabilitative Services enter a Final Order which provides:
That Dr. Herbert Topol, D.O., reimburse the Medicaid Program for $12,311.55 in Medicaid overpayments for 1982.
That Dr. Sylvan Goldin, D.O., reimburse the Medicaid Program for $15,291.11 in Medicaid overpayments for 1982.
That the Topol-Goldin General Practice reimburse the Medicaid Program for $63,341.68 in Medicaid overpayments for 1982.
DONE and ORDERED this 23rd day of September, 1986, in Tallahassee, Florida.
DIANE K. KIESLING, Hearing Officer Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 23rd day of September, 1986.
COPIES FURNISHED:
Herbert Topol, D.O.
1111 W. Broward Boulevard
Ft. Lauderdale, Florida 33312
Sylvan Goldin, D.O.
1111 W. Broward Boulevard
Ft. Lauderdale, Florida 33312
Theodore E. Mack, Esquire 1323 Winewood Boulevard Building One, Suite 407 Tallahassee, Florida 32301
William Page, Jr., Secretary Dept. of HRS
1323 Winewood Blvd.
Tallahassee, Florida 32301
APPENDIX
The following constitute my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all proposed findings of fact submitted by the parties to this case.
Rulings on Petitioners' proposed Findings of Fact
Proposed Finding of Fact 3 is adopted in substance as modified in Finding of Fact 32.
Proposed Finding of Fact 6 is adopted in substance as modified in Finding of Fact 76.
Proposed Finding of Fact 8 is adopted in substance as modified in Finding of Fact 77.
Proposed Finding of Fact 39 is adopted in substance as modified in Finding of Fact 70.
Proposed Finding of Fact 52 is adopted in substance as modified in Finding of Fact 55.
.
6. Proposed Findings of Fact 1, 5, 9, 11, 12, 13, 14, 25, 26,
27, 29, 31, 32, 37, 38, 40, 41, 43, 47 and 48 are rejected as constituting argument and as being conclusory.
7. Proposed Findings of Fact 2, 4, 16, 22, 23, 24, 30, 33, 35,
36, 40, 46, 49 and 50 are subordinate to the fact actually found.
8. Proposed Findings of Fact 7, 10, 17, 18, 19, 20, 21, 34, 38,
40, 42, 44, 45 and 46 are irrelevant and/or unnecessary.
9. Proposed Findings of Fact 17, 25, 28, 32, 43 and 51 are not supported by the competent, substantiated evidence. Additionally, Proposed Findings of Fact 25, 28 and 32 are based on and refer to exhibits which were not admitted in evidence. The exhibits are attached to the proposed order and are rejected as an inappropriate attempt to supplement the record.
Rulings on Respondent's proposed Findings of Fact.
Each of the following proposed Findings of Fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the pro- posed Findings of Fact: 1(1); 2(58); 3(59); 4(60); 5(S1); 6(62); 7(63); 8(64); 9(65); 10(66); 11(67); 12(68); 13(69), 14(70) 15(71); 16(72); 17(60); 18(2); 19(3); 20(4); 21(5); 22(6); 24(7) 25(8); 26(9); 27(10); 28(11); 29(12); 30(13); 31(14); 32(15), 33(16); 34(17); 35(18); 36(19); 37(20); 38(21); 39(22); 40(23). 41(24); 42(25); 43(26); 44(27); 45(28); 46(29); 47(30); 48(31), 49(32); 50(33); 51(34); 52(35); 53(36) 54(37); 55(38); 56(39). 57(40); 58(41); 59(42); 60(43); 61(44); 62(45); 64(46); 65(47) 66(48). 67(49); 68(50); 69(51); 70(53); 74(73); 75(74); 76(76); 79(75); 81(78).
Proposed Findings of Fact 23, 63, and 80 are irrelevant.
Proposed Findings of Fact 71, 72, 73, 77 and 78 are subordinate to the facts found.
| Issue Date | Proceedings |
|---|---|
| Sep. 23, 1986 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Sep. 23, 1986 | Recommended Order | Petitioner over-utilized Medicaid. Petitioner billed/filed improperly (assistant billed Medicaid and patients seen unnecessarily). Department of Health and Rehabilitative Services should recoup overpayments. |
