woes aa pt gt be ocT 15 02 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS RIGA. oo QEPARIMENT CLERK SANTA CLARA PHARMACY, INC. d/b/a SANTA CLARA PHARMACY, Petitioner, Tp apr CASE NO. 01-0753 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, 61:1 kd Si ia 20 Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on Sap fambv 8002, which is 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 _#9_ day of SY ti y , 2002, in Tallahassee, Florida. poate Medows, ca Secretary prRené 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, 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: L. William Porter IJ, Esquire Agency for Health Care Administration (Interoffice Mail) J. Robert Griffin, Esquire J. Robert Griffin, P.A. 1435 E. Piedmont Drive, Suite 210 Tallahassee, Florida 32312 - (U.S. Mail) Ben Metsch, Esquire 1455 NW 14t Street Miami, Florida 33125 (U.S. Mail) J.D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Judy Hefren, Acting Bureau Chief, Medicaid Program Integrity Kathryn Holland, Medicaid Program Integrity Willie Bivens, Finance and Accounting CERTIFICATE OF SERVICE 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 + gay of OCtOQ _, 2002. Chanter Totes ‘D®Lealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 SANTA CLARA PHARMACY, INC. d/bia SANTA CLARA PHARMACY DOAH No, 01-0753 Provider No. 101588500 : C.1. No, 00-0261-000 SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA” or “the Agency"), and Santa Clara Pharmacy, Inc. db/a Santa Clara Pharmacy (‘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 11, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MP) 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 $158,242.25. In response to the audit letter dated January 11, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No; 01-0753. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: , (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. T12°ON EBTIEPSGBET ¢ “bd ‘NASZLAW B NOLTIL C@iet 2807/27/88 (2) PROVIDER agrees to pay one hundred fifty thousand dollars ($150,000) in one lump sum in full and complete settlement of ail claims in the proceedings before the Division of Adiministrative Hearings (DOAH Case No. 01-0763), (3) | PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all llabilities arising from the findings in the audit referenced as C.1, 00-0261-000. (4) 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. 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 monles due and owing to PROVIDER for any Medicaid claims. vad TIc "ON EBISEPIGAST ¢ “Ud ‘YSNZLAW 3 NOLUIL 2@:ET 2002/2e/88 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 either party with respect to this case or any other matter. 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. ) 12, This Agreement constitutes the entire agreement between PROVIDER and the AHCA, 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 of agreements between PROVIDER and the AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties. sed TTZ "ON EBTILPIGZET ¢ “Ud ‘YB9NZLAW 8 NOLTIL ea:et 2GG2/22/88 900 13. This Js 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. 14. 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 all-further and other proceedings to which it may be entitled by law or rules of the Agency regarding this proceeding and any and ail issues ralsed herein. PROVIDER further agrees that it shall not challenge or contest any Final Order entered In this matter which Is consistent with 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. 15, This Agreement is and 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. 16. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. 17. This Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives and trustees. 18. Alltimes stated herein are of the essence of this Agreement, T1Z°ON EBTSEPIGAET € “Ud ‘YS8ZLAW 3 NOLVL COIET 2882/22/88 2@d 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. SANTA CLARA PHARMACY, INC. d/b/a SANTA CLARA PHARMACY Dated: 37/07 7/e_2 , 2002 (Print name) ‘TS: FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 ern Dated: 30 , 2002 Rufus Ngtle Inspector General Lu o~ Dated: Layut- 2 7 , 2002 Valda Glark Christian : Genergi Counsel , 2002 Assistant General Caynsel T12 "ON EBTIIEVSGHET ¢ ‘Ud ‘YS9ZLaW 8 NOWUIL COiET 2002/27/88 een bathed Rheffin ~IAHCA UV AGENCY FOR HEALTH CARE ADMINISTRATION JE8 BUSH, GOVERNOR RUBEN J. KING-SHAW, JR., SECRETARY January 11, 2001 CERTIFIED MAIL - RETURN RECEIPT NO. 7999 0600 0023 5448 2573 Provider No. 1015885 00 License No. PHO000876 Arturo Diaz, President Santa Clara Pharmacy, Inc. d/b/a/ Santa Clara Pharmacy 2296 S.W. 8" Street Miami, Florida 33135 RE: FINAL AGENCY AUDIT REPORT C.I. No. 00-0261-000~3/KNH Dear Mr. Diaz: Medicaid Program Integrity has completed a review of your paid Medicaid claims with dates of seryice from February 1, 1999, through January 31, 2000. We haye also veviewed your product purchase/acquisition documentati You have failed to provide ade that the available quantity of /certain drugs of given strength was aS great as the quantity of those drugs billed to and reimbursed by Medicaid. You are hereby notified that we have determined that Santa Clara Pharmacy was overpaid $158,242.25 for claims that in whole or in‘part are not covered by Medicaid. The total amount due is $158,242.25. The above action and your vight of appeal are discussed below. The Medicaid Provider Agreement states that the provider agrees to participate in the Florida Medicaid program under the terms and conditions specified in the provider agreement. This includes, but is not limited to, complying with federal and state laws, regulations, rules, Medicaid handbooks and policies. Section 409.913(7), Florida Statutes (F.S.), provides that a provider is responsible for the preparation and submission of a claim that is true and accurate and is for goods and services that are provided in accordance with applicable provisions of all Medicaid rules, regulations, handbooks, policies, federal, state, and local laws. . RECEIVED JAN 29 2091 MEDICAID PROGRAM Visit AMBY EAR Meye! wwe fdhe. stare fius 2727 Mahan Drive « Mail Stop #6 Tallahassee, FL 32308 Arturo Diaz, Pre jent Santa Clara Pharmacy, Inc. a/b/a/ Santa Clara Pharmacy Page 2 Section 409.913(8), F.S., requires a Medicaid provider to retain medical,-professional, financial, and business records pertaining to goods and services furnished to a Medicaid recipient for a period of five years after the date of furnishing the goods and services. We have required that you submit invoices from your suppliers to substantiate the availability of drugs that you billed to Medicaid. You have not fully substantiated such availability. Section 409.913(10), F.S., states in part that the Agency may require repayment for inappropriate, medically unnecessary, or excessive goods or services. Section 409.913(14) (n), F.S., states that: “The agency may seek any remedy provided by law, including, but not limited to, the remedies provided in subsecip (12) and (15) and s. 812.035, if: RECEIVE! toe JAN 29 299] “(n) The provider fails to demonstrate that it had MEDICAID program available during a specific audit or review period INTEGRITY sufficient quantities of goods, or sufficient time in the case of services, to support the provider's billings to the Medicaid program;” Billing Medicaid for drugs that have not been demonstrated as available for dispensing is a violation of Medicaid laws and regulations and has resulted in the finding that you have been overpaid by the Medicaid program. The overpayment identified in the summary sheet attachment is with regard only to the 12 drugs listed and comprehends only the period audited,. namely February 1, 1999, through January 31, 2000. A printout identifying all relevant claims involved in the overpayment and a copy of the drug purchase/acquisition review are attached. The overpayment calculation is based upon the assumption that all stock that you have demonstrated as available during the period was exclusively dispensed to Medicaid recipients; this is undoubtedly not the case and the assumption serves to reduce the amount of the calculated overpayment. Medicaid payments that have been substantiated by documented inventory are assumed to be valid; and payments in excess of that amount are regarded to be invalid. . Accordingly, as shown in the summary sheet attachment, we have determined at this time that you have been overpaid by the Medicaid program in the amount of $158,242.25. If additional overpayments are found subsequently, you will be notified. Arturo Diaz, Pres .ent Santa Clara Pharmacy, Inc. d/b/a/ Santa Clara Pharmacy Page 3 If you accept or concur with these findings, please send your check in the amount of $158,242.25, for the identified overpayment, made payable to the Florida Agency for Health Care Administration, to: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 (Note: The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the agency.) To ensure proper credit, be sure that your provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens at (850) 487-4298. You have the right to request a formal or informal hearing pursuant to section 120.569, F.S. Ifa petition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, Florida Administrative Code (F.A.C.). Please note that rule section 28-106.201(2), F.A.C., specifies that the petition shall contain a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days of receipt of this letter. Failure to timely request a hearing shall be deemed a waiver of your right to a hearing. It is important that a request for an informal hearing or a petition for a formal hearing be sent only to the following address: Mr. John A. Owens, Chief Medicaid Program Integrity Office of the Inspector General Agency for Health Care Administration - 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308-5403 ~ Do not send requests or petitions to any other address. Ifa hearing request is not received within 21 days from the date of receipt of this letter, the right to such hearing is waived, and repayment of the above-stipulated overpayment will be due and payable at the end of that 21-day period. Any questions that you may have regarding this matter should be directed to: Ms. Kathryn N. Holland, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, RECEIVED JAN 29 2081 MEDICAID PROGRAM INTEGRITY Arturo Diaz, Pre: ent Santa Clara Pharmacy, Inc. d/b/a/ Santa Clara Pharmacy Page 4 Office of the Inspector General, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone number (850) 922- 4374. ‘ Sincerely, Lay — D. Kenneth Yon Program Administrator Medicaid Program Integrity DKY/knh Attachments cc: Medicaid Program Integrity Administrative Section Willie Bivens, Medicaid Accounts Receivable Medicaid Program Development Area Medicaid Office J. Robert Griffin, Esquire 1435 E. Piedmont Drive Suite 210 Tallahassee, Florida 32312 O:\does\F-santaclaraphy | RECEIVED "yan 29 295] MEDICAID PROGSAM INTEGRITY 0002/£0/80 Q wo 2 & > 8 ge — a a oO wi oS oF , 2 62 U = & Lu 2 . . ‘of STUpz'eSt $ LNSWAVdYSAO IWLOL aS'°SZp'90z$ ge'see'ze ev'SSp 09zr “99 PrOBS'Z =: 1 06Z'ze Ozer Z@0S1 Buoy auldezueiQ 86'ZS0"L 69°eZS'e 2602 0901 IwLZe'e = -29°929'0L ZS1€ cesoz Buz UNeISeAWIS 6P'vEb' EL £2'699't Olly 009 Ltzez'z = SLEOLEL OlLb olees Bwoor wimIpos 9eUa}01919 69°6EL'OL : 00zp 0 \zpipz —- BS"GELOL 00zr oszlp Buz IOH aunaxon}y Olepo'ee 86°62'at 0606 o40S$ =s«ONSE'E = BO'EZF'IS 09th oS p80 Bwoz gjozesdawo 6S'062'P S6PZb's OOP 009} SBlzre ~—pS"S9z'oL 0006 62620 Gwoe ejozesdosuey ZVesi'g 16°622'S $0801 0016 1208S'0 = EOE PLL S046 0081 Bwoor NIAIXOWUEg 62°80S'E4 v2'6Se'| 19z9 oes €SéS''Z ES z98"PrL 1689 ogzee Bwoz IOH eupexoieg og'228' Lt pz'010'e o6sot seoz Eh iztk «= pO'eBB'PL «= S4ZEL =~ gz weasg dig jewejag/ajozewINO|D £2°909'01 o0'66e S6S1 og 666P9'9 —- EZ"SOO'LL SSoL £2809 Bwosz IOH euyeuiqes y2'202'01 BE"P0z'e 9ZLb 00S} = S@9EN'z at -ZOv'eL 9229 £9509 Bwo} eUIpeyes07 were $ peue's ¢ OLte O0pz = zone zs BGL'ZL $ © OSS z00zy Bwo0z qyxooajag 00/TE/TO - 66/10/20 :22!Adag jo satoq 00 G8BSIOI “ON sapiAoug Arvuioyg Dunj> DyuDs

Docket for Case No: 01-000753