STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

CONVAL-CARE, INC., )

)

Petitioner, )

)

vs. ) CASE NO. 92-0126

)

DEPARTMENT OF HEALTH AND )

REHABILITATIVE SERVICES, )

)

Respondent. )

)

RECOMMENDED ORDER

This matter came on for hearing on March 24, 1993, before Robert T. Benton, II, Hearing Officer of the Division of Administrative Hearings, in Tallahassee, Florida. The Division of Administrative Hearings received the hearing transcript on April 8, 1993.

The parties filed proposed recommended orders on May 3 and 4, 1993. The attached appendix addresses proposed findings of fact by number.

APPEARANCES

Samantha D. Boge, Esquire For Petitioner: Stowell, Anton & Kramer

Post Office Box 11059 Tallahassee, Florida 32302

Gordon B. Scott, Esquire For Respondent: Karel Baarslaag, Esquire

1317 Winewood Boulevard Building Six, Room 234

Tallahassee, Florida 32399-0700 STATEMENT OF THE ISSUES

Whether the Department of Health and Rehabilitative Services (HRS) should take disciplinary action against petitioner for the reasons alleged in the sanctions letter dated November 4, 1991?

PRELIMINARY STATEMENT

By letter dated November 4, 1991, HRS alleged that it had sought unsuccessfully to "obtain records in the possession of Conval-Care, Inc. (CCI)." The letter stated:

Since the records have not been provided,

and since you refused access to the records in your letter of October 21, 1991 to Mr. Gordon Scott, the department is hereby imposing an

administrative fine of $1,000 per day on Conval-Care, Inc. effective October 22, 1991 as authorized by Chapter 409.913(9)(c), F.S.

The sanctions letter acknowledged the statutory cap of $25,000.00 on administrative fines "in connection with any one audit or investigation."

In response to the sanctions letter, CCI contested the proposed fine by filing a petition for formal hearing, which included a request "that a subsequent petition for attorney's fees be heard by the hearing officer and granted pursuant to section 57.111, F.S." HRS forwarded CCI's petition to the Division of Administrative Hearings, in accordance with Section 120.57(1)(b)3., Florida Statutes (1992 Supp.).

FINDINGS OF FACT

1. Billings for home health care services once made CCI the recipient of substantial Medicaid moneys. By resort to, among other things, "a variety of different types of statistical investigations," (T.82) the Office of Program Integrity within HRS' Medicaid Office is "continuously asking the question, do we get what we pay for?" Id. A separate, legislative agency, a unit of the Office of the Auditor General, investigates allegations of Medicaid fraud.

   
   

   Investigation

   
   

2. In February of 1990, Ellen Williams, a medical health care program analyst in HRS' Office of Program Integrity, noticed that CCI was "suddenly showing up as either number one or number two in the State, and . . . was intrigued why a home health agency in Palatka would be [b]illing to the extent it appeared that they were." T.36. She "requested a printout of their billings" (T.37) and opened a file.

   
   

3. Not long afterwards, Ms. Williams learned that the Medicaid Fraud Control Unit (MFCU) in the Auditor General's Office "had basically a new review of the same agency." T.37. MFCU investigators copied "a number of boxes" (T.116) of CCI's records, including "pieces of files" for ten of the 49 patients whose files HRS subsequently attempted to obtain from CCI. T.53. As far as the evidence showed, MFCU did not obtain "the entire files on any of these people." Id.

   
   

4. In early May of 1990, Ms. Williams received an unsigned investigative report the Medicaid Fraud Control Unit had prepared. On the strength of this report, at her supervisor's direction, she prepared a letter which was sent to CCI by certified mail on May 20, 1991. Petitioner's Exhibit No. 3. She did not attempt at that time to verify the allegations in the MFCU report.

   
   

   Prosecution

   
   

5. The letter dated May 20, 1991, initiated a recoupment and termination proceeding, Conval-Care, Inc. v. Department of Health and Rehabilitative Services, No. 91-4020, intended to end CCI's "participation in the Florida Medicaid program for [alleged] violation of federal and state laws and regulations respecting the Medicaid program," stating:

   
   

   Information has been received from the Medicaid Fraud Control Unit of the Office of the Auditor General (MFCU) to the effect that

   you have billed and been paid $591,082.00 for services that are not covered by Medicaid.

   
   

   Petitioner's Exhibit No. 3. HRS also sought to recover the alleged overpayment, and impose an administrative fine. The letter did not allege times. (HRS later concluded that the overbillings alleged in the letter occurred between December of 1989 and November of 1990, but HRS never sought leave to amend to allege this, and took no other step to limit the allegations in the recoupment and termination proceeding.) In response to CCI's request for formal administrative proceedings, HRS referred Case No. 91-4020 to the Division of Administrative Hearings.

   
   

   Discovery and Further Investigation

   
   

6. On September 23, 1991, while Case No. 91-4020 was pending at the Division of Administrative Hearings, HRS' Ellen D. Williams wrote CCI's Inez Browning, as follows:

   
   

   In order to complete the Medicaid review of services billed by Conval-Care, Inc. to the Department of Health and Rehabilitative Services, it will be necessary to obtain completed home health records on a selected statistical sample of recipients.

   
   

   I plan to arrive at your Palatka office on Tuesday, October 8, 1991, for the purpose of copying the records for the individuals on the attached list. Please have them available at that office. If you have any problems or questions, please call me at (904) 488-3588.

   
   

   Respondent's Exhibit No. 1. Although not identified as such, the list of names was purportedly a random sample of Medicaid beneficiaries to whom CCI had provided services between December of 1989 and May of 1991, a period during which CCI's alleged overbillings were even higher.

   
   

7. In response to Ms. Williams' letter of September 23, 1991, counsel for CCI wrote Ms. Williams, on September 30, 1991, as follows:

   
   

   Please recall that your office, due in large part to your actions, is involved in litigation with Conval-Care, Inc. As a result, any request for documents must be pursued through appropriate discovery channels pursuant to the Florida Rules of Civil Procedure. No records will be provided as a result of your letter of September 23rd. If you appear at the door, you will be refused entry.

   
   

   You referred to a "statistical sample" of recipients, yet requested information concerning both recipients whose records have already been provided and the remaining recipients whose records were not provided during the initial investigation. This hardly

   reflects any statistical sampling. Further, your letter contradicts your sworn testimony in which you indicated there was no pending investigation of Conval-Care, Inc. by DHRS.

   
   

   In any event, Conval-Care, Inc. is a represented party in active litigation with your agency and neither you or any other representative from DHRS may contact Conval- Care, Inc. or any of its employees without my consent. You and others at the agency may have realized the weakness of your claims against Conval-Care, Inc., since the credibility of several of your key witnesses has been seriously undermined, but we will not permit you to go on a fishing expedition to try to develop new allegations against our client.

   
   

   You made your case Ms. Williams, now live with it. If DHRS must seek other documents related to the matters at issue, its attorneys should know how to do that.

   
   

   Respondent's Exhibit No. 2. HRS did not file any request for production in Case No. 91-4020 under Fla. R. Civ. P. 1.310(b), 1.350 or 1.351, which are applicable to administrative proceedings by virtue of Rule 60Q-2.019, Florida Administrative Code.

   
   

8. Instead, attaching the same list of 49 names that Ms. Williams had attached to her letter of September 23, 1991, counsel for HRS wrote CCI's counsel, on October 17, 1991, as follows:

   
   

   Pursuant to Chapter 400.484 and 409.913 Florida Statutes, representatives of the Department of Health and Rehabilitative Services intend to copy certain records in the possession of Conval-Care, Inc. It is their intention to go to your clients place of business on Tuesday, October 22, 1991 and obtain these copies.

   
   

   I have attached a list of those records which are of interest.

   
   

   Please advise the undersigned if this date is inconvenient.

   
   

   Respondent's Exhibit No. 3. Some, but not all, of the listed records concerned patients for whom reimbursement between December of 1989 and November of 1990 was at issue in Case No. 91-4020.

   
   

9. On October 21, 1991, in response to Mr. Scott's letter dated four days earlier, Respondent's Exhibit No. 3, Julie Gallagher wrote, on behalf of CCI:

   
   

   Section 400.487, F.S., grants HRS the authority to make "such inspections and

   investigations as are necessary in order to determine the state of compliance with the provisions of this act and of rules or standards in force pursuant thereto." It is our position that HRS has already made such "inspections and investigations" and has determined that Conval-Care, Inc. is not in compliance with various provisions of the statute and rules and, hence, HRS has initiated termination proceedings to exclude Conval-Care, Inc. from the Medicaid Program. Further "inspections and investigations" are not necessary as required by the statute and will, therefore, not be permitted. The other statute you cited, Section 409.903 [sic], F.S., has nothing to do with the inspection of documents.

   
   

   Should you desire documents from Conval-Care, Inc., which are pertinent to the issue in the pending litigation, please submit a discovery request and we will respond appropriately.

   
   

   Respondent's Exhibit No. 4. Insisting it had the right to inspect the records in question, HRS sent Ms. Williams to Palatka where, as CCI's counsel had forewarned, nobody from CCI was on hand to receive her.

   
   

   Main Case Abandoned

   
   

10. "In the month or so preceding" (T.52) September 23, 1991, Ms. Williams came to believe "that what MFCU referred to . . . as their sample was not in fact a [random] sample . . . [and] did not encompass the entire billing period." Id. At hearing, she testified that she wanted "to determine an overpayment amount, irrespective of the termination proceeding." T.60. But at the time this desire arose HRS was seeking to recover the "overpayment amount" in Case No. 91-4020, the recoupment and termination proceeding in which final hearing was then set for October 14, 1991.

    
    

11. HRS' counsel in the recoupment and termination proceeding relied on the attempt to obtain records Ms. Williams initiated on September 23, 1991, as his sole means of securing records that HRS listed as exhibits it intended to offer in the recoupment and termination proceeding, Case No. 91-4020. Petitioner's Exhibit No. 7.; T. 134-5. After the attempt to gather evidence in this fashion proved unavailing, and after several continuances, HRS dropped the recoupment and termination proceeding it had initiated against CCI.

    
    

    CONCLUSIONS OF LAW

    
    

12. Since HRS referred CCI's hearing request to the Division of Administrative Hearings, in accordance with Section 120.57(1)(b)3., Florida Statutes (1992 Supp.), "the division has jurisdiction over the formal proceeding." Section 120.57(1)(b)3., Florida Statutes (1992 Supp.).

    
    

13. Section 409.913, Florida Statutes (1991) grants HRS broad authority to safeguard "the integrity of the Medicaid program."

    The department shall operate a program to oversee the activities of Medicaid recipients, and providers and their representatives, to ensure that fraudulent and abusive behavior and neglect of recipients occur to the minimum extent possible.

    1. The department shall conduct, or cause to be conducted by contract or otherwise, investigations, analyses, and audits of possible fraud, abuse, and neglect in the Medicaid program and shall report the findings therefrom in departmental audit reports as appropriate.

       . . .

       (6) A Medicaid provider shall retain professional and financial records pertaining to services and goods furnished to a Medicaid recipient and billed to Medicaid for a period of 5 years after the date of furnishing such services or goods.

       
       

       Section 409.913, Florida Statutes (1991). When investigations, analyses or audits give rise to allegations of fraud, abuse or neglect, HRS institutes and prosecutes recoupment and termination proceedings in conformity with the Administrative Procedure Act.

       
       

14. Medicaid providers are under a duty to cooperate in these investigations, analyses and audits. Section 409.913, Florida Statutes (1991) authorizes HRS to "impose administrative sanctions against a Medicaid provider if:

    
    

    1. The provider has refused access to Medicaid-related records to an authorized auditor or investigator acting as an employee or agent of the department, the Auditor General, a state attorney, or the Federal Government;

    2. The provider has not furnished, upon reasonable notice, such Medicaid-related records as the department found necessary to determine whether Medicaid payments are or were due and the amounts thereof;

    
    

    Section 409.913(8), Florida Statutes (1991). As additional authority for requiring production of CCI's Medicaid records, HRS relies on Section 400.484, Florida Statutes (1991), but the latter statute does not seem to pertain to "Medicaid-related records." 1/

    
    

15. Section 409.913, Florida Statutes (1991) must be read in pari materia with the Administrative Procedure Act. HRS's investigatory powers notwithstanding, HRS lacked authority to effect discovery in Case No. 91-4020, while the case was pending at the Division of Administrative Hearings, except in conformity with applicable rules 2/ and statutes, including Section 120.57(1)(b)3., Florida Statutes (1992 Supp.), which provides, in part:

The referring agency shall take no further action with respect to the formal proceeding,

except as a party litigant, as long as the division has jurisdiction over the formal proceeding.

With respect to Case No. 91-4020 (as in the present case) HRS was the "referring agency." Once the recoupment and termination case was docketed at the Division of Administrative Hearings, HRS was not free to obtain discovery by means unavailable to CCI, the other litigant. Central to the essential character of the Division of Administrative Hearings as a neutral forum is the requirement that state agencies litigating questions of fact do so on an equal footing with non-governmental parties.

1. Of course, the Administrative Procedure Act evinces no purpose to strip an agency of its ability to investigate unrelated matters (even concerning the same party) merely because the agency has referred a particular matter to the Division of Administrative Hearings, in accordance with Section 120.57(1)(b)3., Florida Statutes (1992 Supp.)

   
   

2. Here HRS maintains that it sought information pertinent to unrelated matters in demanding access to records which included some that CCI generated after the period MFCU originally investigated. But the allegations at issue in Case No. 91-4020 did not limit the claim of overpayments to the time covered by the MFCU investigation. The only temporal limit on claims communicated to CCI was that implicit in the May 20, 1991 date of HRS' initial letter (after which CCI's operations ceased, and no overbillings are alleged to have occurred.) Taken as a whole, the evidence in the present case requires the inference that HRS intended to offer the records it demanded access to as evidence in Case No. 91-4020.

   
   

3. Strict procedural protections apply in disciplinary cases, and the prosecuting agency's burden is to prove its case clearly and convincingly. Ferris vs. Turlington, 510 So.2d 292 (Fla. 1987). See Addington vs. Texas, 441

U.S. 426 (1979); Ferris vs. Austin, 487 So.2d 1163 (Fla. 5th DCA 1986);

Anheuser-Busch, Inc. vs. Department of Business Regulation, 393 So.2d 1177 (Fla. 1st DCA 1981); Walker vs. State Board of Optometry, 322 So.2d 612 (Fla. 3rd DCA 1975); Reid vs. Florida Real Estate Commission, 188 So.2d 846, 851 (Fla. 2nd DCA 1966). HRS has not met its burden here. As far as the evidence shows, CCI did nothing more than insist that HRS obtain discovery in Case No. 91-4020 in the manner prescribed by law.

RECOMMENDATION

It is, accordingly, RECOMMENDED:

That HRS dismiss the sanctions letter which initiated these proceedings.

DONE AND ENTERED this 30th day of June, 1993, in Tallahassee, Florida.

ROBERT T. BENTON, II

Hearing Officer

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 30th day of June, 1993.

ENDNOTES

1/ The home health agency licensing law does not specifically address Medicaid issues. Section 400.484, Florida Statutes (1991), entitled "Right of inspection," provides:

Any duly authorized officer or employee of the department shall have the right to make such inspections and investigations as are necessary in order to determine the state of

compliance with the provisions of this act and of rules or standards in force pursuant thereto. . . .

But the act to which the statute refers is the Home Health Services Act, which as its purpose

to provide for the licensure of every home health agency which is certified or seeks certification as a Medicare home health service provider and to provide for the development, establishment, and enforcement of basic standards which will ensure and safe and adequate care of persons receiving Medicare health services in their own homes.

Section 400.461, Florida Statutes (1991). The Home Health Services Act contains provisions on the establishment and review of plans of treatment, clinical records, confidentiality of information, screening of home health agency personnel, advertising home health agency services, and other matters, but makes no mention of Medicaid or of financial records kept for Medicaid purposes.

2/ In accordance with Section 120.58, Florida Statutes (1991), Rule 60Q-2.019, Florida Administrative Code, makes the Florida Rules of Civil Procedure governing discovery applicable to formal administrative proceedings at the Division of Administrative Hearings.

APPENDIX

Petitioner's proposed findings of fact Nos. 1, 2, 3, 8, 11, 12, 13, 14, 17,

19 and 20 have been adopted, in substance, insofar as material.

With respect to petitioner's proposed findings of fact Nos. 4 and 6, the letters are set out in the findings of fact.

Petitioner's proposed findings of fact Nos. 5 and 10 pertain to subordinate matters.

With respect to petitioner's proposed finding of fact No. 7, she testified that the file was open.

With respect to petitioner's proposed finding of fact No. 9, Ms. Gallagher forbade HRS' contacting CCI without her consent.

With respect to petitioner's proposed finding of fact No. 9, a HRS letter cited Section 409.913, Florida Statutes.

With respect to petitioner's proposed finding of fact No. 15, it was not clear that all records wire identical.

With respect to petitioner's proposed finding of fact No. 16, Ms. Williams "thought it was ever record." T.115.

With respect to petitioner's proposed finding of fact No. 18, Ms. Williams did not doubt the accuracy of the records MFCU used.

Respondent's proposed findings of fact Nos. 1, 2, 3, 4, 5, 6, 7, 9, 12, 13,

14, 15, 16, 17, 18, 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 31 and 33 have been

adopted in substance, insofar as material.

With respect to respondent's proposed findings of fact Nos. 8 and 10, the letter of May 20, 1991, made no mention of December 1989 or November 1990, nor were the allegations in Case No. 91-4020 ever narrowed to a particular time period (other than, by necessary implication, "pre-initiation.")

With respect to respondent's proposed finding of fact No. 19, she did not succeed in obtaining all the records.

Respondent's proposed findings of fact Nos. 22 and 32 are properly proposed conclusions of law.

With respect to respondent's proposed finding of fact No. 34, the request could also have produced admissible evidence.

COPIES FURNISHED:

Robert Powell, Agency Clerk Department of Health and

Rehabilitative Services 1323 Winewood Boulevard

Tallahassee, Florida 32399-0700

John Slye, General Counsel Department of Health and

Rehabilitative Services 1323 Winewood Boulevard

Tallahassee, Florida 32399-0700

Samantha D. Boge, Esq. Stowell, Anton & Kramer Post Office Box 11059 Tallahassee, Florida 32302

Gordon B. Scott, Esq. Karel Baarslaag, Esq. 1317 Winewood Boulevard Building Six, Room 234

Tallahassee, Florida 32399-0700

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions to this Recommended Order. All agencies allow each party at least 10 days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the final order in this case concerning agency rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the final order in this case.

=================================================================

AGENCY FINAL ORDER

=================================================================

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

CONVAL-CARE, INC.,

Petitioner,

vs. CASE NO.: 92-0126

RENDITION NO.: AHCA-93-124 FOF-MDC

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

/

FINAL ORDER

This cause came on before me for the purpose of issuing a final agency order. The Hearing Officer assigned by the Division of Administrative Hearings (DOAH) in the above-styled case submitted a Recommended Order to the Agency for Health Care Administration (AHCA). The Recommended Order entered June 30, 1993, by Hearing Officer Robert T. Benton, II is incorporated by reference.

RULING ON EXCEPTIONS

The issue in this case is whether the agency can impose an administrative fine on a Medicaid provider who refused the agency's demand for access to the provider's files while a proceeding was pending to terminate the provider's status as a Medicaid provider and to recover large amounts of money previously paid by Medicaid. 1/ The Hearing Officer acknowledged the agency's statutory authority to demand provider records and to impose fines where access is denied, but the Hearing Officer also found an implicit exception to this authority when the demanded records may be relevant to a pending Section 120.57 proceeding against the provider. The Hearing Officer relied on the Administrative Procedure Act in concluding that Section 120.57(b)3 was intended to place the parties on equal footing with regard to discovery in an adjudicatory proceeding. The Hearing Officer further reasoned that because the non-governmental party can

only take discovery as provided by the Rules of Civil Procedure, the state should also be limited to discovery under those rules.

While the legal issue presented is a close call, I disagree with the Hearing Officer for the following reasons:

One, the private party is not limited to discovery under the Rules of Civil Procedure. The private party is given in effect "open file discovery" of the government agency's file under Chapter 119, Public Records. See Section 119.07, Florida Statutes. The agency s authority to demand access to provider records (Section 409.913) maintains the balance rather than upsetting it by giving the agency in effect "open file discovery". So long as evidentiary privileges are respected, fundamental rights are not jeopardized by open file discovery. In order to protect such privileges, both public records demands and agency access demands should be made through counsel when the demanded records may be relevant to a pending 120.57 proceeding. There was no issue of privilege in the present case.

Two, the stakes are enormous. A major portion of public funds, federal and state, are spent for health care. The legislature has cited a study by the federal General Accounting Office which estimated that up to ten percent of health care expenditures are the result of fraud and abuse. See Section 57 of the Health Care and Insurance Reform Act of 1993, Chapter 93-129, Laws of Florida. Because of the dollars involved and the numbers and sophistication of health care providers, uncovering fraud and abuse is a daunting challenge. This agency has an important role in this task and it must use all the tools made available to it. It goes without saying that unfettered access to provider records is an important tool.

Third, no health care provider is required to be a Medicaid provider.

Medicaid is a joint federal - state program to provide health care access to indigent persons. When a provider seeks and is given status as a Medicaid provider it submits itself to the regulatory authority of the state, including access to its files. I conclude that where there is conflict between the specific regulatory statutes and the general provisions of the Administrative Procedure Act, the regulatory statutes should prevail.

I disagree with the Hearing Officer's conclusion that the burden of proof in a disciplinary proceeding where a professional license is not at stake is the clear and convincing standard. The Hearing Officer relied on Ferns vs.

Turlington, 510 So2d 292 (Fla. 1987). Ferris is applicable to revocation of a professional license, not imposition of lesser sanctions. The correct burden of proof here is the preponderance test. Alien vs. School Board, 571 So2d 568 (Fla. 3rd DCA 1990).

FINDINGS OF FACT

1. The agency hereby adopts and incorporates by reference the findings of fact set forth in the Recommended Order.

   
   

   CONCLUSIONS OF LAW

   
   

2. The agency hereby adopts and incorporates by reference the conclusions of law set forth in the Recommended Order except where inconsistent with the Ruling On Exceptions. Having concluded that Petitioner lacked authority to reject the demand for access to its records, it follows that the agency has the authority to impose sanctions. It appears that Petitioner acted on the advice

of counsel in refusing the demand; thus, mitigation of the penalty is appropriate. The fine is therefore reduced from $25,000.00 to $5,000.00.

Based upon the foregoing, it is

ADJUDGED, that a fine of $5,000.00 be imposed on Petitioner, Conval-Care, Inc. The fine shall be paid by check or money order made payable to Treasurer, State of Florida. The check or money order shall be mailed or delivered to AHCA, Medicaid Program, Gordon Scott, Esquire, 1317 Winewood Boulevard, Building 6, Room 234, Tallahassee, Florida, 32399-0700. The fine shall be paid no later than 30 days after the rendition of this Final Order.

DONE and ORDERED this 19 day of 1993, in Tallahassee, Florida.

DOUGLAS M. COOK, Director Agency for Health Care Administration

ENDNOTE

1/ The only factual conclusion challenged by counsel is the Hearing Officer's finding in paragraph 16 that the agency intended to offer as evidence in the termination case records it demanded from the provider. Counsel did not challenge the finding in paragraph 7 that some of the demanded records were relevant to the termination case or the finding in paragraph II that after the provider refused the demand the agency dismissed the termination proceeding.

The challenged finding is supported by competent, substantial evidence; therefore, the exception is denied.

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEES PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.

COPIES FURNISHED:

Gordon Scott, Esquire Senior Attorney

1317 Winewood Boulevard

Building 6, Room 234

Tallahassee, Florida 32399-0700

Samantha D. Boge, Esquire STOWELL, ANTON & KRAMER

Post Office Box 11059 Tallahassee, Florida 32302

Robert T. Benton, II Hearing Officer

The DeSoto Building 1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named people by U.S. Mail this 21st day of 1993.

R. S. Power, Agency Clerk State of Florida, Agency for Health Care Administration

325 John Knox Road

The Atrium Building, Suite 301 Tallahassee, Florida 32303

(904)922-3808

Docket for Case No: 92-000126

Orders for Case No: 92-000126