STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS QUEST, D/B/A LAUREL HILL CLUSTER,

Petitioner,

Case No. 09-4278

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2015 SEP 18 P 2: 02

vs.

AGENCY FOR HEALTH CARE ADMINISTRATION ,

Examination No.: DD04-0191 Provider No.: 280194

Respondent.

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FINAL ORDER

THIS CAUSE is before me for issuance of a Final Order. In a letter dated June 30, 2009, Examination No. DD04-19I, Quest, d/b/a Laurel Hill Cluster, ("Petitioner" or "Provider") was informed that the State of Florida, Agency for Health Care Administration ("Respondent" or

"AHCA") had completed an examination of Respondent's Medicaid cost report for the reporting period specified in the letter . The letter consisted of an examination report that notified Provider of adjustments to its cost report for the reporting period specified in the letter. Adjustments to the cost report impact the rate of Medicaid payments to Provider. A retroactive rate adjustment can result in an overpayment determination for which Provider is obligated to repay. The examination report letter is attached hereto and incorporated by reference herein (Attachment A).

The examination report letter was sent Certified Mail, return receipt requested, to Provider at the address last shown on the provider enrollment file. The letter contained full disclosure and notice regarding Provider's administrative hearing and due process rights.

In response to the examination letter, Provider timely filed with AHCA a Petition for a Formal Administrative Hearing (" Petition" ) challenging the examination report with the adjustments to the cost report (Attachment B). The Petition was forwarded to the Division of Administrative Hearings (DOAH) for assignment to an Administrative Law Judge and assigned DOAH Case No. 09-4278. Upon a Motion to Relinquish Jurisdiction filed by AHCA, on August 27, 2009, the DOAH Judge issued an Order Closing File . On August 27, 2015, Provider through counsel filed a Notice of Dismissal of the Petition (Attachment C).

FINDINGS OF FACT

1. Provider was provided notice of the examination adjustments as set forth in the attached examination report letter, Examination No. DD04-19I (Attachment A).

2. The examination report letter disclosed Provider's administrative and due process rights.

3. By filing a Notice of Dismissal of the Petition (Attachment C), Provider no longer disputes the facts set forth in the examination report letter (Attachment A). Therefore,

   
   

   
   

   Filed September 23, 2015 4:57 PM Division of Administrative Hearings

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   those facts, each and every one, are hereby deemed admitted, and form the factual basis for the cost report adjustments as well as any rate adjustments. including retrospective rate adjustments.

   
   

   CONCLUSIONS OF LAW

   
   

4. The Agency incorporates and adopts the statements and conclusions of law as set forth in the attached examination report letter, Examination No. No. DD04-19I (Attachment A).

5. The admitted facts support the conclusion that the cost report adjustments are true and accurate and form the basis for any corresponding rate adjustments.

6. Provider is advised that the rate adjustments will be assessed immediately and any overpayments which resulted are due and owing to the Agency. Notice of the rate adjustment and any overpayments which result from the retroactive rate adjustment will be conveyed to Provider. At that time, Provider is obligated to repay the overpayment or make satisfactory arrangements with the Agency.

7. Provider is also advised that pursuant to Section 409.913(15)(k), Florida Statutes, the Agency is required to apply an administrative sanction where a subsequent cost report includes a cost that is not allowable under a Florida Title XIX reimbursement plan, after having been advised that the costs were not allowable; therefore, Provider is advised that any costs that were disallowed by way of the examination report letter on the basis that the cost is not allowable under a Florida Title XIX reimbursement plan are prohibited in any future cost report.

ORDER

BASED on the foregoing, it is ORDERED and ADJUDGED that the Petition for Formal Administrative Hearing is hereby dismissed with prejudice; that Provider's cost report be adjusted as set forth in the attached examination report letter, Examination No. DD04-19I (Attachment A); that the Agency recalculate the Medicaid reimbursement rate; and that any retroactive rate adjustment which results in an overpayment is now due and owing to the Agency, together with such statutory interest as is set forth in the Florida Statutes.

DONE AND ORDERED this IT'th day of ..Sqpf12.m6er

Leon County, Florida.

, 2015, in Tallahassee,

ELIZXBETH D EK, SECRETARY

AGENCY FOR HEALTH CARE ADMINISTRATION

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 FEE AS PRESCRIBED BYLAW, 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 to:

The Honorable Lawrence P. Stevenson Administrative Law Judge

Division of Administrative Hearings

Bruce Lamb, Esquire Attorney for Provider

401 E Jackson ST, STE 2500

Tampa, FL 33602-5236

blamb@gunster.com (Email Transmission)

Stuart F. Williams, General Counsel Agency for Health Care Administration (Email Transmission)

Shena Grantham, Chief Medicaid FPS Counsel (Email Transmission)

Agency for Health Care Administration

Bureau of Financial Services (Email Transmission)

Bureau of Health Quality Assurance Agency for Health Care Administration

(Email Transmission)

Zainab Day, Medicaid Audit Services Agency for Health Care Administration

(Email Transmission)

Debora E. Fridie

Assistant General Counsel (Email Transmission)

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CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy e foregoing has been furnished to the above named addressees by email transmission this of <- S-- t..,,.,,--,

2015.

Richard J. Shoop, Esquire Agency Clerk

State of Florida

Agency for Health Care Administration 2727 Mahan Drive, Building #3

Tallahassee, Florida 32308-5403

(850) 412-3630 (Telephone)

(850) 921-0158 (Fax)

Docket for Case No: 09-004278

Orders for Case No: 09-004278