Elawyers Elawyers
Washington| Change

THE BISCAYNE INSTITUTE vs AGENCY FOR HEALTH CARE ADMINISTRATION, 03-001837 (2003)

Court: Division of Administrative Hearings, Florida Number: 03-001837 Visitors: 24
Petitioner: THE BISCAYNE INSTITUTE
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: CLAUDE B. ARRINGTON
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: May 19, 2003
Status: Closed
Recommended Order on Tuesday, June 15, 2004.

Latest Update: Apr. 25, 2008
Summary: Whether Petitioner is entitled under Florida’s workers’ compensation laws to payment for professional services to an injured worker for the billings identified by the three notices of disallowance at issue in this consolidated proceeding.Disallowance of payment for rehabilitation services that were not reasonable or medically necessary should be sustained.
(9-15 04 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION /6E! THE BISCAYNE INSTITUTE, 1th SEP-9 A $58 Petitioner, DOAH CASE NOs. 03-1837, -1838, -3890 vs. RENDITION NO. AHCA- 0420 - or QS maad a (Ze) AGENCY FOR HEALTH CARE yt a 6 ADMINISTRATION, : = Respondent ar and OA: CW 7 = cnt CITY OF HOLLYWOOD AND FLORIDA no LEAGUE OF CITIES, Intervenors. / esse FINAL ORDER This cause was referred to the Division of Administrative Hearings and assigned to an Administrative Law Judge (ALJ) for a formal administrative hearing and the entry of a Recommended Order. The Recommended Order of June 15, 2004, is attached to this Final Order and incorporated herein by reference. RULING ON EXCEPTIONS The petitioner filed exceptions to findings of fact 3, 4, 6, 7, 8, 9, 10, 28-31 collectively, and 32-33 collectively. The petitioner also filed one collective exception to conclusions of law 36-38. The exceptions are denied for the reasons set forth below. Each specific exception to each of the above-listed finding of fact simply restates evidence already presented at the hearing, and does nothing more than dispute the ALJ’s evidentiary findings; they do not establish an absence of competent substantial evidence.__See generally Section 120.57(1)(1), Fla. Stat. (providing in pertinent part that “(t)he agency may not reject or modify the findings of fact unless the agency first determines from a review of the entire record...that the findings of fact were not based upon competent substantial evidence.”), Heifetz v. Department of Bus. Regulation, 475 So.2d 1277, 1281 (Fla. 1985) (holding that an agency “may not reject the hearing officer’s finding (of fact) unless there is no competent, substantial evidence from which the finding could reasonably be inferred.”). The record shows that the ALJ’s findings of fact are supported by competent substantial evidence. Therefore the petitioner’s exceptions to the findings of fact are denied. Section 120.57(1)(1) provides in pertinent part: The agency may adopt the recommended order as the final order of the agency. The agency in its final order may reject or modify the conclusions of law over which it has substantive jurisdiction and interpretation of administrative rules over which it has substantive jurisdiction. When rejecting or modifying such conclusion of law or interpretation of administrative rule, the agency must state with particularity its reasons for rejecting or modifying such conclusion of law or interpretation of administrative rule and must make a finding that its substituted conclusion of law or interpretation of administrative rule is as or more reasonable than that which was rejected or modified. The conclusions of law to which petitioner excepts, numbers 36 through 38, are verbatim quotes of Sections 440.13(7), 440.13(1)(u), and 440.13(1)(1), Florida Statutes. The Agency cannot modify or reject these conclusions; that would amount to amendment of a statute, authority for which lies with the Legislature. Petitioner’s exception does not implicate the reasonableness of the conclusions of law. Therefore the petitioner’s exceptions to the conclusions of law are denied. FINDINGS OF FACT The Agency adopts the findings of fact set forth in the Recommended Order. CONCLUSIONS OF LAW The Agency adopts the conclusions of law set forth in the Recommended Order. IT IS THEREFORE ADJUDGED THAT: The disallowances at issue in these consolidated proceedings are sustained. DONE and ORDERED in DOAH Case Nos. 03-1837, -1838 and —3890 this Ddaay of MN , 2004, in Tallahassee, Florida. ALAN LEVINE, SECRETARY Agency for Health Care Administration NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY, ALONG WITH THE FILING FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail to the persons named below on this Gq day of pumo1h. 2004. FOz Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 COPIES FURNISHED TO: William R. Pfeiffer Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Kim Kellum, Esquire Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 Charles D. Jamieson, Esquire Ward, Damon, & Posner, P.A. 4420 Beacon Circle West Palm Beach, FL 33404 Timothy Byrnes Medicaid Program Integrity Kelly Benpétt Medjéaid Program Integrity John Hoover Medicaid Finance and Accounting

Docket for Case No: 03-001837
Issue Date Proceedings
Apr. 25, 2008 Letter to Clerk from G. Indest regarding request for deposition transcript from DOAH file filed.
Apr. 23, 2008 Letter to Clerk from G. Indest regarding request for certified copies filed.
Jan. 21, 2005 THIRD DISTRICT COURT ORDER: Appellant is ordered to file a response within 10 days of the date of this order to the joint motion to transfer appeal.
Dec. 03, 2004 Notice of Appeal of Final Administrative Action filed.
Nov. 17, 2004 Notice of Firm`s Change of Address (filed by J. Hoffman via facsimile).
Nov. 05, 2004 Corrected Final Order filed.
Sep. 10, 2004 Final Order filed.
Jul. 01, 2004 Exceptions to Recommended Order (filed Petitioner via facsimile).
Jun. 15, 2004 Recommended Order cover letter identifying the hearing record referred to the Agency.
Jun. 15, 2004 Recommended Order (hearing held March 15-18, 2004). CASE CLOSED.
Jun. 11, 2004 Intervenors` Request for Official Notice (filed via facsimile).
Jun. 02, 2004 Order Granting Motion to Accept Late Filing (of Proposed Recommended Order revisions).
Jun. 01, 2004 (Proposed) Recommended Order (filed by S. Stark via facsimile).
Jun. 01, 2004 Motion to Accept Late filing of Revisions to Proposed Recommended Order (filed by S. Stark via facsimile).
Jun. 01, 2004 Letter to S. Stark from M. Spangler regarding Respondent`s/Intervenors` Joint Proposed Recommended Order filed.
May 28, 2004 (Proposed) Recommended Order (filed by S. Stark via facsimile).
May 28, 2004 Respondent`s/Intervenors` Joint Proposed Recommended Order filed.
May 19, 2004 Order Granting Extension of Time to File Proposed Recommended Orders.
May 18, 2004 Petitioners` Unopposed Motion for Extension of Time to Submit Proposed Order (filed in DOAH Case No. 03-3890 via facsimile).
Apr. 22, 2004 Second Amended Certificate of Service for Notice of Attorney`s Retaining Lien filed by G. Indest III.
Apr. 20, 2004 Transcript (Volumes I - VII) filed.
Apr. 07, 2004 Notice of Filing Petitioner`s Composite Exhibits 1 through 37 Marked at the March 15-18, 2004 Administrative Hearing (filed by Petitioner via facsimile).
Apr. 07, 2004 Letter to Judge Arrington from M. Spangler regarding enclosed Intervenors exhibit No. 14 (filed via facsimile).
Apr. 06, 2004 Amended Notice of Status Conference (filed by M. Spangler via facsimile).
Apr. 02, 2004 Letter to Judge Arrington from M. Spangler regarding Petitioner`s exhibit 16 (filed via facsimile).
Mar. 31, 2004 Exhibits (1box) filed.
Mar. 30, 2004 Exhibits (6 boxes) filed.
Mar. 26, 2004 Letter to Judge Arrington from M. Spangler regarding enclosed exhibits filed.
Mar. 15, 2004 CASE STATUS: Hearing Held.
Mar. 12, 2004 Joint Pre-hearing Stipulation (filed via facsimile).
Mar. 12, 2004 Petitioner`s Motion to take Telephonic Testimony at Administrative Hearing Scheduled to Commence March 15, 2004 (filed via facsimile).
Mar. 12, 2004 Intervenors` Motion of Filing and Request for Judicial Notice (1993 Senate Report) filed.
Mar. 11, 2004 Letter to Judge Arrington from D. Riselli regarding the enclosed exhibits to deposition of Merle Barnett filed.
Mar. 11, 2004 Amended Notice of Hearing (hearing set for March 15 through 19, 2004; 10:30 a.m.; Miami, FL; amended as to location).
Mar. 11, 2004 Intervenors` Motion of Filing and Request for Judicial Notice filed.
Mar. 10, 2004 Letter to Judge Arrington from M. Spangler regarding agreed dates for the administrative hearing (filed via facsimile).
Mar. 08, 2004 Notice of Taking Deposition Duces Tecum (M. Barnett) filed via facsimile.
Mar. 05, 2004 Order Granting Petitioners` Motion to Drop Marie DiCowden as a Party Petitioner
Mar. 03, 2004 Re-Notice of Taking Videotaped Deposition for Use at Hearing (Dr. V. Batas) filed via facsimile.
Mar. 03, 2004 Letter to Judge Arrington from M. Spangler regarding the scheduled status conference (filed via facsimile).
Mar. 01, 2004 Notice of Taking Videotaped Deposition for Use at Hearing (Dr. V. Batas) filed via facsimile.
Mar. 01, 2004 Intervenors` Motion for Protective Order (filed via facsimile).
Mar. 01, 2004 Notice of Telephonic Hearing (filed by M. Spangler via facsimile).
Feb. 26, 2004 Exhibits to Intervenors` Motion to Compel Production of Medical Evaluation Records and Reports filed by M. Spangler.
Feb. 26, 2004 Notice of Taking Deposition Duces Tecum of Corporate Respresentative (filed via facsimile).
Feb. 26, 2004 Petitioners` Motion to Drop Marie DiCowden as Party Petitioner (filed via facsimile).
Feb. 25, 2004 Notice of Taking Deposition (A. Raphael, Ph.D) filed via facsimile.
Feb. 25, 2004 Notice of Taking Deposition (K. Fischer, M.D.) filed via facsimile.
Feb. 25, 2004 Intervenors` Motion to Compel Production of Medical Evaluation Records and Reports (filed via facsimile)
Feb. 24, 2004 Deposition (of Jorge Villalba, M.D.) filed.
Feb. 24, 2004 Deposition (of David P. McCraney, M.D.) filed.
Feb. 24, 2004 Deposition (of Fernando G. Miranda, M.D.) filed.
Feb. 24, 2004 Telephonic Deposition (of Gerard Garcia) filed.
Feb. 24, 2004 Deposition (of Thomas G. Hoffman, M.D.) filed.
Feb. 24, 2004 Deposition (of Marie DiCowden) filed.
Feb. 24, 2004 Deposition (of Richard S. Bailyn, M.D.) filed.
Feb. 24, 2004 Intervenors` Notice of Filing Depositions filed.
Jan. 30, 2004 Intervenors` Second Set of Interrogatories to Petitioners (filed via facsimile).
Jan. 30, 2004 Intervenors` Notice of Service of Second Set of Interrogatories to Respondents (filed via facsimile).
Jan. 30, 2004 Intervenors` Fourth Request for Production to Petitioners, Marie A Dicowden, Ph.D., and the Biscayne Institutes (filed via facsimile).
Dec. 15, 2003 Order Granting Continuance and Re-scheduling Hearing (hearing set for March 15 through 19, 2004; 10:30 a.m.; Miami, FL).
Dec. 11, 2003 Intervenors` Response to Petitioners` Motion to Continue (filed via facsimile).
Dec. 11, 2003 Notice of Hearing (filed by S. Stark via facsimile).
Dec. 09, 2003 Petitioners` Motion for Continuance of Final Hearing (filed via facsimile).
Dec. 05, 2003 Intervenors` Third Request for Production to Petitioners, Marie A Dicowden, Ph.D, and the Biscayne Institutes (filed via facsimile).
Dec. 04, 2003 Letter to J. Benoit from M. Spangler regarding served subpoenas (filed via facsimile).
Dec. 03, 2003 Intervenors` Second Request for Production to Petitioners, Marie A Dicowden, Ph.D, and the Biscayne Institutes (filed via facsimile).
Dec. 03, 2003 Notice of Telephonic Hearing (filed by M. Spangler via facsimile).
Nov. 25, 2003 Order Denying Motion for Protective Order.
Nov. 25, 2003 Petitioners` Emergency Motion for Protective Order (filed via facsimile).
Nov. 17, 2003 Amended Notice of Taking Telephonic Deposition Duces Tecum (G. Garcia) filed.
Nov. 17, 2003 Second Amended Notice of Taking Deposition Duces Tecum (D. McCraney, M.D.) filed.
Nov. 17, 2003 Notice of Taking Telephonic Deposition Duces Tecum (G. Garcia) filed.
Nov. 17, 2003 Amended Notice of Taking Deposition Duces Tecum (4), (D. McCraney, M.D., T. Hoffman, M.D., R. Bailyn, M.D., and F. Miranda, M.D.) filed.
Nov. 17, 2003 Notice of Taking Deposition Duces Tecum (6), (J. Villalba, M.D., D. McCraney, M.D., T. Hoffman, M.D., R. Bailyn, M.D, F. Miranda, M.D., and M. DiCowden Ph.D) filed.
Nov. 17, 2003 Notice of Service of Intervenors` Supplemental Answers to Petitioners` Expert Interrogatories filed.
Nov. 13, 2003 Intervenors` Motion to Compel Production of Documents and Answers to Interrogatories Propounded on Petitioners (filed via facsimile).
Nov. 04, 2003 Letter to J. Hoffman from M. Spangler regarding the rescheduling of serveral depositions (filed via facsimile).
Oct. 29, 2003 Order Granting Continuance and Re-scheduling Hearing (hearing set for January 5 through 9, 2004; 10:30 a.m.; Miami, FL).
Oct. 28, 2003 Unilateral Response to Initial Order and Motion to Consolidate (Cases requested 03-3890, 03-1937, and 03-1838) filed via facsimile.
Oct. 28, 2003 Order of Consolidation Case: 03-003890 was added to the consolidated batch.
Oct. 27, 2003 Notice of Appearance (filed by S. Stark, Esquire, via facsimile).
Oct. 24, 2003 Order Abating Discovery.
Oct. 22, 2003 Letter to Judge Arrington from M. DiCowden regarding request for continuance (filed via facsimile).
Oct. 13, 2003 Amended Order Granting Motion to Withdraw.
Oct. 13, 2003 Amended Certificate of Service for Notice of Attorney`s Retaining Lien (filed by G. Indest, III via facsimile).
Oct. 13, 2003 Notice of Filing, Letters from G. Indest to Dr. DiCowden (filed by G. Indest via facsimile).
Oct. 08, 2003 Notice of Attorney`s Charging Lien (filed by G. Indest, III via facsimile).
Oct. 08, 2003 Notice of Attorney`s Retaining Lien (filed by G. Indest, III via facsimile).
Oct. 07, 2003 Letter to Judge Arrington from M. DiCowden objecting to Mr. Indest`s withdrawal unless a continuance is granted to obtain qualified counsel (filed via facsimile).
Oct. 06, 2003 Order Correcting Style of Case. (the style of these consolidated proceedings will be corrected to reflect that DiCowden and Biscayne are Petitioners, the Agency is the Respondent, and City of Hollywood and Florida League of Cities have intervened on behalf of the Respondent agency)
Oct. 06, 2003 Order Granting Motion to Withdraw. (George F. Indest, III, motion to withdraw is granted; all future pleadings will be served on Marie A. DiCowden and the Biscayne Insitute, 2785 Northeast 183 Street, Miami, Florida 33160)
Oct. 03, 2003 (Proposed) Order on Motion to Withdraw as Attorney (filed via facsimile).
Oct. 03, 2003 Motion to Withdraw as Attorney (filed by G. Indest, III via facsimile).
Sep. 26, 2003 Notice of Taking Deposition (M. Barnett, R.N.) filed via facsimile.
Sep. 24, 2003 Intervenors` Response to Respondents` Request to Produce filed.
Sep. 24, 2003 Intervenors` First Request for Production to Respondents, Marie A Dicowden, Ph.D., and the Biscayne Institutes filed.
Sep. 24, 2003 Intervenors` Notice of Service of First Set of Interrogatories to Respondent, Marie A. Dicowden, Ph.D and the Biscayne Institutes filed.
Sep. 23, 2003 Agency for Health Care Administration`s Notice of Compliance with Petitioner`s First Request to Produce filed.
Sep. 22, 2003 Agency for Health Care Administration`s Motion for Correct Scrivenor`s Error filed.
Sep. 22, 2003 Respondent`s Reply to Petitioner`s Second Request for Production filed by D. Riselli.
Sep. 19, 2003 Cross-Notice of Taking Deposition Duces Tecum, D. McCraney (filed via facsimile).
Sep. 15, 2003 Cross-Notice of Taking Deposition Duces Tecum J. Villalba, M.D. (filed via facsimile).
Sep. 15, 2003 Respondents, Marie A. Dicowden, Ph.D and the Biscayne Institutes`, Second Request for Production to Petitioner, Agency for Health Care Administration filed.
Sep. 09, 2003 Petitioner, Agency for Health Care Administration`s Responses to Respondent`s First Set of Interrogatories (filed via facsimile).
Sep. 09, 2003 Petitioner, Agency for Health Care Administration`s Notice of Service of Responses to Respondent`s First Set of Interrogatories (filed via facsimile).
Sep. 08, 2003 Order Granting Continuance and Re-scheduling Hearing (hearing set for December 1 through 5, 8 through 12, 2003 and January 5 through 9, 2004; 9:00 a.m.; Miami, FL).
Sep. 05, 2003 Letter to Judge Arrington from M. Spangler responding to Respondent`s motion for continuance and enlargement of time for final hearing filed September 3, 2003 (filed via facsimile).
Sep. 03, 2003 Respondents` Motion for Continuance and Enlargement of Time for Final Hearing (filed via facsimile).
Aug. 29, 2003 Notice of Service of Intervenors` Answers to Respondents` Expert Interrogatories (filed via facsimile).
Aug. 29, 2003 Intervenors` Response to Respondents` Motion for Mediation (filed by M. Spangler via facsimile).
Aug. 26, 2003 Respondents` Motion to Compel Answers to Expert Interrogatories from Agency filed.
Aug. 26, 2003 Respondents` Motion for Mediation filed.
Aug. 25, 2003 Respondents` Motion to Compel Proper Answers to Requests for Admissions from Agency filed.
Aug. 08, 2003 Respondent`s First Request for Admissions to Petitioner, Agency for Health Care Administration filed.
Aug. 08, 2003 Petitioner`s Response to Request for Admissions (filed via facsimile).
Aug. 04, 2003 Respondents, Marie A. Dicowden, PH.D. and the Biscayne Institutes`, Notice of Service of First Set of Interrogatories to Petitioner, Agency for Health Care Administration filed.
Aug. 01, 2003 Respondents, Marie A. Dicowden, PH.D. and the Biscayne Institutes`, First Request for Production to Petitioner, Agency for Health Care Administration filed.
Aug. 01, 2003 Respondents` First Request for Production to Intervenors, City of Hollywood and Florida League of Cities filed.
Aug. 01, 2003 Respondents` Notice of Service of Expert Interrogatories to Intervenors, City of Hollywood and Florida League of Cities filed.
Jul. 07, 2003 Marie A. Dicowden, Ph.D. and the Biscayne Institutes`s Response to Petitioner`s Request for Production of Documents filed.
Jul. 07, 2003 Marie A. Dicowden, Ph.D. and the Biscayne Institutes` Notice of Serving Answers to Petitioner`s First Set of Interrogatories filed.
Jul. 03, 2003 Letter to A. Cole from L. Breir requesting subpoenas filed.
Jul. 02, 2003 Order Granting Continuance and Re-scheduling Hearing (hearing set for October 6 through 10, 2003; 10:00 a.m.; Miami, FL).
Jul. 01, 2003 Motion for Reconsideration of Dates Set for Hearing or in the Alternative Continuance filed by Petitioner.
Jul. 01, 2003 Notice of Substitution of Counsel and Request for Service (filed by D. Riselli, Esquire).
Jun. 26, 2003 Order Granting Intervention. (Intervenor, City of Hollywood and Florida of Cities)
Jun. 13, 2003 Employee/Carrier`s Petition for Leave to Intervene as an Interested Party filed.
Jun. 10, 2003 Letter to J. Daniels and G. Indest, III from Judge Arrington enclosing a copy of an article received from an unknown source.
Jun. 03, 2003 Order of Pre-hearing Instructions issued.
Jun. 03, 2003 Notice of Hearing issued (hearing set for September 8 through 12, 2003; 10:00 a.m.; Miami, FL).
Jun. 02, 2003 Order of Consolidation issued. (consolidated cases are: 03-001837, 03-001838)
May 28, 2003 Joint Response to Initial Order (filed via facsimile).
May 20, 2003 Initial Order issued.
May 19, 2003 Notice of Disallowance of Payments filed.
May 19, 2003 Dr. Dicowden`s and the Biscayne Institutes` Request for a Formal Hearing filed.
May 19, 2003 Notice (of Agency referral) filed.
May 19, 2003 Petitioner`s First Set of Interrogatories, and Request for Production of Documents (filed via facsimile).

Orders for Case No: 03-001837
Issue Date Document Summary
Nov. 01, 2004 Agency Final Order
Sep. 02, 2004 Agency Final Order
Jun. 15, 2004 Recommended Order Disallowance of payment for rehabilitation services that were not reasonable or medically necessary should be sustained.
Source:  Florida - Division of Administrative Hearings

Can't find what you're looking for?

Post a free question on our public forum.
Ask a Question
Search for lawyers by practice areas.
Find a Lawyer