STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS Fi y mE dD PULMONARY PRESCRIPTION PROVIDERS, INC., Petitioner, : ae vs. CASE NO. 00-1243 EM AUDIT NO. 96-1484- 000 % RENDITION NO. AHCA-OT2 STATE OF FLORIDA, e AGENCY FOR HEALTH CARE Z ADMINISTRATION, Respondent. FINAL ORDER THE PARTIES resolved all disputed issues and executed, a Settlement Agreement on ”/ b , 2001, which “4s incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the / (hay of fon [, 2001, in Tallahassee, Florida. ile~ R .fking-Shaw, Jr., 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 BY LAW, AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY WITH THE DISTRICT COURT OF APPEAL IN .THE APPELLATE DISTRICT WHERE THE ~ RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: L. William Porter, Esquire Agency for Health Care Administration (Interoffice Mail) Louise T. Jeroslow, Esquire Kirkpatrick & Lockhart, LLP 201 S. Biscayne Boulevard Miami, Florida 33131 Ken Yon, Medicaid Program Integrity Willie Bivens, Finance and Accounting DOAK CERTIFICATE OF SERVICE BE FILED I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the (20) day of , 2001. RA. Powhr, Agency Clerk State of Florida quire “2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 Agency for Heaith Care Administration PULMONARY PRESCRIPTION PROVIDERS, INC. DOAH No. 00-1243 Provider No. 101910400 C.1. No. 96-1484-000 SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA" or “the Agency”), and Pulmonary Prescription Providers, Inc. (‘PROVIDER’), by and through the undersigned, hereby stipulate and agree as follows: 1. This Agreement is entered into between the parties for the purpose of avoiding the costs and burdens of litigation, and neither party concedes the other's position. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its final agency audit report dated January 48, 2000, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $218,090.59. In response to the audit letter dated January 18, 2000, PROVIDER filed a petition for a format administrative hearing which was assigned DOAH Case No. 00-1243. 4, In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: ..(4) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (3) (4) (6) (6) HOTEL Ue ue a ee Within ninety (90) days of receipt of a final order, PROVIDER agrees to pay to AHCA the total sum of twenty-eight thousand nine hundred forty-one dollars and sixty cents ($28,941 60), $21,441.60 for the overpayment, $5,000 for purchases from an unlicensed wholesaler, and $2,500 assessed for investigative costs, in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 00-1243). PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.|, 96-1484-000. PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit In this case, AHCA agrees that this matter did not constitute fraud and abuse of the Medicaid program, and was a matter of inadvertence on the part of the PROVIDER. AHCA agrees to make this known to any agency or entity, not limited to Boards or professional regulation entities. , PROVIDER agrees to cooperate fully with ANCA, including voluntary truthful testimony, or any government agency, in future Investigations or prosecutions having to do with the facts and ~ Circumstances of this case. FEB-89-2881 @B755 AGENCY FOR HEALTH CARE AD OU Gis YSIS ro 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 6. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute PROVIDER'S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to PROVIDER for any Medicaid claims. 7. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 8. This settlement does not constitute an admission of wrongdoing or error by aither party with respect to this case or any other matter. However, the parties believe that this matter should be settled because the parties have agreed to the terms contained within this agreement. ) 9. Each party shall bear its own attorneys’ fees and costs, if any. 10. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. 11. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida. FEB-9-2aRi Bs AGENCY FOR HEALTH CARE AD 858 413 9313 P.B 42. In the event that a party breaches this Agreement, and enforcement of this Agreement or recovery of damages for breach hereof is obtained by law or by legal proceedings through an attomey at law, all costs of collection or enforcement, including reasonable attorneys’ fees, shall be paid by the breaching party to the non-breaching party. 13. This Agreement constitutes the entire agreement between PROVIDER and the AHGA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between PROVIDER and the AHCA other than as set forth herein. No modification or waiver of any provision shail be valid unless a written amendment to the Agreement is completed and properly executed by the parties. 14. This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions, as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions” as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 45. PROVIDER expressly waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and ail further and other proceedings to which it may be entitled by law or rules of the ‘Agency regarding this proceeding. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this Foeo-es cur wor MU UN rm oy we WL 2040 r. matter which incorporates the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 16. This Agreement is ahd shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it. ; 17. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent nat so prohibited, and such prohibition shall not affect any other provision of this Agreement. 18. This Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives and trustees, 19. All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. PULMONARY PRESCRIPTION PROVIDERS, INC. ITS: = aw dere meee pee oe eee oe ‘ ELORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 L. William Porter It Assistant General Coun: TOTAL P.87

Docket for Case No: 00-001243