STATE OF FLORIDA J DIVISION OF ADMINISTRATIVE HEARINGS PALATKA HEALTH CARE CENTER, Petitioner, ATS. Ches vs. DOAH CASE NO. 01-1151 ENGAGEMENT NO. NHO0-006M PROVIDER NO. 200794 AGENCY FOR HEALTHCARE Prardduen lo ALO OS12-S MDA ADMINISTRATION, — Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement, 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 £.3_ day of tne , 2003, in Tallahassee, Florida. Rhonda M. “tobe s, MD, Sttretary 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, 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: Garnett Chisenhall Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Mr. Joseph Mitchell Mitchell & Company, CPA’s 2851 Remington Green Circle, Suite D Tallahassee, Florida 32308 (U.S. Mail) Barbara Staros Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Bob Maryanski, Bureau Chief, Medicaid Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has A been furnished to the above named addressees by U.S. Mail on this the £9 day of _( “td, 2003. VG . 4 7 (ihe datens J dU Li £ 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 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS PALATKA HEALTH CARE CENTER, Petitioner, vs. DOAH CASE NO. 01-1151 ENGAGEMENT NO. NH00-006M PROVIDER NO. 200794 AGENCY FOR HEALTHCARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH’ CARE ADMINISTRATION (“AHCA” or “the Agency”), and Petitioner PALATKA HEALTH CARE CENTER (‘the PROVIDER”), by and through the undersigned, 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. 2. The PROVIDER is a Medicaid provider in the State of Florida operating a facility that was audited by the Agency. 3. In audit engagement NH00-006M, AHCA audited the PROVIDER’S cost report for the audit period ending January 31, 1998. 4. In its Audit Report issued on January 31, 2001, pursuant to the foregoing audit engagement, AHCA notified the PROVIDER that a review of its cost report showed, in its opinion, some claims in whole or in part were not reimbursable by Medicaid. The Agency further notified the PROVIDER of the adjustments AHCA was making to the cost report. In response to the Audit Report, the PROVIDER filed a timely petition for an administrative hearing that was assigned DOAH case number 01-1151. 5. In the petition for an administrative hearing, the PROVIDER identified specific adjustments being contested. 6. Subsequent to issuance of the Audit Report, AHCA and the PROVIDER exchanged documents and discussed the disputed adjustments. 7. As a result of the foregoing discussions, the parties agree the Agency's adjustments which are the subject of this proceeding, pertaining to the cost report of the PROVIDER for the audit year ending January 31, 1998 (audit engagement number NH00-006M), shall be as follows: a. Adjustment #4 will be reduced from $(4,190.00) to $(238.00). b. Adjustment #12 will be reduced from $(3,765.00) to $(975.00). c. Adjustment #19 will be reduced from $(2,577.00) to $(775.00). d. Adjustment #26 will be reduced from $(51,428.00) to $(4,549.00). e. Adjustment #44 will be removed. f. Adjustment #6 will be reduced from $171,031.00 to $69,994.00. g. Adjustment #35 will be reduced from $(119,556.00) to $(18,519.00). h. Adjustment #25 will be removed. i. Adjustment #59 will be removed. j. Adjustment #15 will be removed. k. The adjustment to Capital Additions and Improvements, shown on page 6 on the audit report (Schedule of Fair Rental Value System Data) will be reduced from $(1,419,154.00) to $(605,411.00). 8. In order to resolve this matter without further administrative proceedings, the PROVIDER and AHCA expressly agree the adjustment resolutions, as set forth above, completely resolve and settle this case and this agreement constitutes the PROVIDER’S withdrawal of the petition for administrative hearing, with prejudice. 9. The PROVIDER and AHCA further agree the Agency shall recalculate the per diem rate for these time periods, and issue a notice of the recalculation. Where the PROVIDER was overpaid, the PROVIDER will remit payment to the Agency in the full amount of the overpayment within thirty (30) days of such notice. Where the PROVIDER was underpaid, AHCA will remit payment to the PROVIDER in the full amount of the underpayment within forty-five (45) days of such notice. 10. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL, 32317-3749 Notices to each Provider shall be made to: National Healthcare Corporation C/o Pam Williams Reimbursement Manager 100 Vine Street, City Center Murfreesboro, Tennessee 37130 Payment shall clearly indicate it is pursuant to a settlement agreement, shail reference the Case Number, and shall reference the audit/engagement number. 11. The PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute the PROVIDER’S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement frora any monies due and owing to the PROVIDER for any Medicaid claims. 12. AHCA is entitled to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable law. 13. This settlement does not constitute an admission of wrongdoing or error by the parties with respect to this case or any other matter. However, the parties believe this matter should be settled because they have agreed to the foregoing terms. 14. Each party shall bear their respective attorneys’ fees and costs, if any. 15. The signatories to this Agreement, acting in their respective representative capacities, are duly authorized to enter into this Agreement on behalf of the party represented. The parties further agree a facsimile or photocopy reproduction of this Agreement shall be sufficient for the parties to enforce the Agreement. The PROVIDER agrees, however, to forward a copy of this Agreement to AHCA with original signatures, and understands a Final Order may not be issued until said original Agreement is received by AHCA. 16. 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. 17. This Agreement constitutes the entire agreement between the PROVIDER and AHCA, including anyone acting for, associated with, or employed by them, respectively, concerning all matters and supersedes any prior discussions, agreements, or understandings; there are no promises, representations, or agreements between the PROVIDER and 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. 18. This is an Agreement of settlement and compromise, recognizing 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. 19. The PROVIDER expressly waives in this matter its right to any hearing pursuant to §§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 all issues raised herein, other than enforcement of this Agreement. The PROVIDER further agrees the Agency shall issue a Final Order which is consistent with the terms of this settlement, that adopts this Agreement and closes this matter. 20. 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. 21. To the extent 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. 22. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives, and trustees. Palatka Health Care Center Muro Heres Dated: Y-2I- OF (signatufe) By its: fees, DENT (title) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Kobe Brge— Dated: C)) 2/o be) Bob Sharpe, Deputy Secretary, Medicaid ely IAA Fail Dated: EL VII Valda Clark Christian, General Counsel pow awk Cc Kine Acll Dated: ¥/- ay fc oF Garnett Chisenhall, Assistant General Counsel

Docket for Case No: 01-001151