) ) ) ) JOSE E. SANCHEZ-ARGUELLO, M.D.,_ ) ) _) PILED "STATE OF FLORIDA OOMAY 30 PH I: 55 DEPARTMENT OF HEALTH ~ DEPARTMENT OF HEALTH, PETITIONER, QO O- Z 2a 7 es vs. CASE NO. 1998-13908 ___ RESPONDENT. ADMINISTRATIVE COMPLAINT ‘ as, COMES NOW ‘the Petitioner, ‘Department of Health, hereinafter referred to as “Petitioner,” and files this Administrative Complaint before the Board of Medicine against Jose B. Sanchez-Arguello, MD, hereinafter referred to as “Respondent,” and alleges: 1. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.43, F lorida Statutes; Chapter 455, Florida Statutes, and Chapter 458, Florida Statutes. Pursuant to the authority of Section 20.43(3), Florida Statutes, the Petitioner has contracted with the Agency for Health Care Administration to provide _. consumer complaint, investigative and prosecutorial services required by the Division of Medical _ Quality Assurance, councils, or boards, as appropriate. ny ae Respondent is and has been at all times material hereto a licensed physician in the _ State of Florida, having been issued license number ME 0034751. -Respondent’s last known ; ° address is 6651 Southwest 100" Street, Miami, Florida 33156, — R pondent i is s board-« certi in Surgery. err oor i Medicaid Provider Fraud i in violation of Section 409. 920(2)(a), ), Fi . ; . . 7 . 7 : en 4 Onc or about April 20, 1998, Melanie Hines, Statewide Prosecutor for the State of Florida, filed an Information against Dr. Sanchez-Arguello i in the Circuit Court of the Eleventh Judicial Circuit for Dade County, Florida in Case Number 98-13381. The Information charged Dr. Sanchez-Arguello with one count of participating in an organized scheme to defraud the State of Florida Medicaid Program and/or the State of Florida Unysis and/or the State of F lorida Agency for Health Care Administration i in n violation of Section 817. 034(4)(a)(3) 2 and 777.011, Florida Statutes, one. gount of Paying an n undercover investigator for the purpose of billing services to the Medicaid Program, in violation of Section 409.920(2)(e) and 777.011, “Florida Statutes, and two counts of filing false statements with the Medicaid Program that medical services had been provided when in fact said services had not, in claims relating to an undercover agent Posing as a 2 Medicaid recipient in violation of Section 409. 920(2)(a) and . 777. ou, “Florida Statutes. 5. On or about March 2, 1999, Dr. Sanchez-Arguello entered into a plea agreement in Case Number 98- 13381 1 in the Cireuit Court of the Eleventh Judicial Circuit for Dade County, Florida. Dr. Sanchez-Arguello agreed to plead guilty to one count of engaging in an organized scheme to defraud in violation of Section 817.034(4)(a)(3), Florida Statutes, and two counts of rida Statutes, Tn addition, Dr. Sanchez-Arguell agreed to cooperate with the Statewide Prosecutor i in the prosecution of cases - against 0 other individuals or entities that } he supervised or - which utilized his name to bill the State : of Florida Medicaid Program. 6. eo n_exchange for the’ terms described above, the State of Florida agreed to _Tecommend to othe Circuit Court a sentence of three ©@) years probation, withhold adjudication, a $1,000.00 fine, payment of $4,000.00 to ‘the Statewide Prosecutor’s office for the cost of pepe 7 investigation, payment of $4,000.00 to the Attorney General, Medicaid Fraud Control Unit, and restitution of $100,000.00 to the Agency for Health Care Administration, with $30, 000. 00 to be paid prior to the court accepting the plea ‘and the remainder to be paid within the first two years of probation. 7. On or about March 2, 1999, a Judgment was entered in Case Number 98-13381 in the Circuit Court for the Eleventh Judicial Circuit in which the court found Dr Sanchez-Arguello guilty of one count of engaging i ~ fraud. Pursuant to the terms of the Plea Agreement, the court withheld adjudication and ordered Dr. Sanchez-Arguello to pay the charges and costs agreed to in the plea agreement, as well as county and local costs and charges. 8. On or about November 17, 1999, the Circuit Court of the Eleventh Judicial Ped organized scheme to defraud and t two counts of Medicaid ‘Circuit entered separate Judgment and Restitution Orders Nunc Pro Tunc back to March 2, 1999, against Dr. Sanchez-Arguello for each of the departments and agencies that Dr. Sanchez- Arguello was s ordered to make restitution to in Case Number 98- 133814. 9 On o or about December 2, 1999, ‘the Department received certified copies of the Information, Plea Agreement, Sentence, and Judgment and Restitution Order for the Agency for “Health Care Administration « enterée in se ‘Nitmber 98-1 13381A in the Circuit Court of the .Eleventh Judicial Circuit for Dade County, Florida. 10. Petitioner realleges and incorporates 15 paragraphs one =) through nine « (9), as if fully set forth herein this Count One. ee ET SER TR reer U v) 11. Respondent was ‘convicted or found guilty of, or entered a plea of nolo contendre to, regardless of adjudication, 4 time in any jurisdiction which directly relates to the practice of medicine or to the ability to practice medicine, in that Respondent entered a guilty plea to one count of engaging in an organized scheme to defraud the Florida Medicaid Program, in violation _of Section 817.034(4)(a)(3), Florida Statues, and two counts of Medicaid Provider Fraud in -_ violation of Section 409. 920(2)@). | OS 12: - Based on the foregoing, Respondent t has violated Section 458. 8.331 ()(c), Florida “Statutes, by by being convicted or found 1 guilty of, or - entering a plea of nolo contendere ‘to, : regardless of adjudication, 2 a crime in any jurisdiction which directly relates to 9 the practice of medicine or to the ability to practice medicine. : - WHEREFORE, the Petitioner respectfully requests the Board of Medicine enter an ‘order imposing one or more of the following penalties: permanent revocation or suspension of the Respondent s license, restriction of the Respondent s practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, the =a assessment of costs related to the investigation and prosecution of this case as provided for in Section 455. 624(4), Florida Statutes, and/or any other relief that the Board deems appropriate. Seed aaa 2000. ‘Robert G G. . Brooks, ] MD., , Secretary DEPARTMENT OF HEALT? oso DEPUTY CLERK ~ CLERK Uebi R Mine _ pate 4 12. O SRR RRR \) WwW COUNSEL FOR DEPARTMENT: _ Kathryn L. Kasprzak Chief Medical Attorney Agency for Health Care Administration P. O. Box 14229 Tallahassee, Florida 32317-4229 Florida Bar #0937819 KLK/kmk ; PCP: April 24, 2000 PCP Members: Cerda, Pardue sos penne pepe eee nerve ee ree ae ag TER RE IRE OEE 4. STATEOF FLORIDA ~~ DEPARTMENT OF HEALTH EXPLANATION OF RIGHTS In response to the allegations set forth in the Administrative Complaint issued by the Department of Health, hereinafter referred to as the Department, by and through the Department’s contract counsel, the Agency for Health Care Administration, you should make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint. Please make your election on the attached Election of Rights form and return it fully executed to the address listed on the form. 1. If you do not dispute any material fact alleged in the Administrative Complaint, you may request a proceeding pursuant to Section 120.57(2), Florida Statutes, before the Board of Medicine. At this proceeding, you will be given an opportunity to present both written and oral evidence in mitigation. This request should be directed to the Department by checking the appropriate space, marked as 1, on the Election of Rights form within twenty-one (21) days from the date of receipt of the Administrative Complaint. : 2. If you do not dispute any material fact alleged in the Administrative Complaint and you do not desire to participate in the disposition of the case, you may elect choice 2 on the Election of Rights form. 3. If you dispute any material fact alleged in the Administrative Complaint, you may request.a formal hearing and the appointment of an Administrative Law Judge to be furnished by the Division of Administrative Hearings of the Department of Management Services pursuant to Section 120.569(2)(a), Florida Statutes, by checking the appropriate space, marked as 3, on the Election of Rights form. If you elect a formal hearing, you ,.must keep the Department informed as to your current mailing address. Failure to do so may be considered a “-waiver of your right to a formal hearing. : - 4, Regardless of whether you dispute any material fact alleged in the Administrative Complaint, you may request the opportunity to enter into a settlement agreement of this case, pursuant to Section 120.57(4), Florida Statutes. {f an agreement is agreed to by you and the Department, the matter will be presented to the Board of Medicine for approval. Please be advised that a settlement agreement is considered a disciplinary act and is reported as such. ~~ In the event that you fail to make an election in this matter within twenty-one (21) days from receipt of the Administrative Complaint, your failure to do so may be considered a waiver, pursuant to Rule 28-106.111(4), Florida Administrative Code, and the Board may proceed to hear your case. Saeed atc adidtadadiess ata ee eS Biwi ate tere wee ee oe hi alias uli taal & allie. s- ebsikin E. | STATE. OF FLORIDA HC wighen of Administrative Hearings ae 4 y ne ° by RUBEN ulbclou JR, on JEB BUSH, GOVERNOR , Le Becks { 4 Hl ia « htc aR ia QU 71. PERSONAL AND CONFIDENTIAL Jose E. Sanchez-Arguello, M.D. 6651 Southwest 100" Street Miami, Florida 33156 Re: Case No. 1998-13908 Go- 2 ATS Dear Dr. Sanchez-Arguello: . Enclosed please find an Administrative Complaint which has been filed against you by the Department of Health. Also enclosed is an election of rights form and an Explanation of rights form. Please execute and return the Election of Rights form within 21 days from receipt of this letter. Your signature must be notarized. Failure to act within this 21-day period may result in the entry of a Default Judgement against your license or permit. As a result of the finding of probable cause, this file became a “public record” under state law. A few lawyers in private practice regularly request copies of administrative complaints filed after a case becomes a “public record.” It is possible that you will receive a letter depicted as an “advertisement” from one or more of these lawyers seeking to represent you. These persons have no association with the Department or the Agency for Health Care Administration in any way. You may retain your own attorney or proceed with this matter’in the way you desire. , 2727 MAHAN DRIVE TALLAHASSEE, FL 32308 | me yu, LS oom | ay Bes: peil27, 2000 i A i i Ac ia ll a acebbdllics daa. con eeetllihiee in ibis 6 thn abide AR a Cl RU a a iM i Le oo Tf you have any questions, please.do not hesitate to contact me at (850) 414-8126, by fax =~ at (850)414-1989, by TDD at 1-800-955-8771, or by mail at Office of the General Counsel, Medical Section, P.O. Box 14229, Tallahassee, FL 32317-4229. Sincerely, ON fi : Ad Clie “Kathryn L. Kasprzak Chief Medical Attorney Coins we mrtes oy Agency for Health Care Administration KLK/kmk : Enclosure _ ce: Chris Parrella, Esquire ~~~ 799 Brickell Avenue, Ste 700 Miami, Florida 33131 -

Docket for Case No: 00-002273