STATE OF FLORIDA LINCOURT PHARMACY AGENCY FOR HEALTH CARE ADMINISTRAHQM, FILED GaENCY FOR RE ADMINIST DEPUTY CLERK RATION Petitioner, DAT! vs. STATE OF FLORIDA CASE NO. 01-1966MPI /< AGENCY FOR HEALTH CARE ADMINISTRATION err | PROVIDER NO. 102009900 ? AUDIT C.I. NO. 00-1061-000- 3¢, > Respondent / RENDITION NO.: AHCA-04- c2b3s FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED _o DONE and ORDERED on this the _//~ day of _ “74 2004 in Tallahassee, Florida. fo Mary Pat Moore, te 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, 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 II, Esquire Agency for Health Care Administration (Interoffice Mail) Marcos Hasbun, Esquire Zuckerman Spaeder LLP 101 E. Kennedy Boulevard, Suite 1200 Tampa, Florida 33602-5838 (U.S. Mail) Robert Meale Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity JoAnn JacksSay Mecicaid Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has b rnished to the above named addressees by U.S. Mail on this the Z day fo) , 2004. o2 Lealand 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 we Lay 24 PH 2:23 DIVISION OF ADMINISTRATIVE HEARINGS &* © LINCOURT PHARMACY, AL ‘ Petitioner, vs. CASE NO. 01-1966 PROVIDER NO. 102009900 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Lincourt Pharmacy (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. This Settlement Agreement (“Agreement”) is entered into between AHCA and PROVIDER, and its predecessors and successors, for the purpose of completely resolving this administrative dispute between them under C.I. No. 00-1061-000-3/H/GWM, and avoiding costs and burdens of further litigation. Neither party concedes the other’s position. 2. At the times material to the audit, which is the subject of this agreement, PROVIDER was a Medicaid provider in the State of Florida, provider number 102009900. 3. In its Final Agency Audit Report (final agency action) dated April 6, 2001 (C.I. No. 00-1061-000-3/H/GWM), AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (‘MPI’), Office of the AHCA Inspector General, indicated certain claims, in whole or in part, had been inappropriately paid by Medicaid. A copy of the April 6, 2001 Final Agency Report (C.I. No. 00-1061-000-3/H/GWM) is attached hereto Lincourt Pharmacy Settlement Agreement as Exhibit “A”. In particular, AHCA alleged that Medicaid had overpaid PROVIDER on a judgmental sample review and a separate statistical analysis of a random sampling of claims submitted during the audit period, which was from September 28, 1998 through March 24, 2000. AHCA also alleged that the drug quantity billed to Medicaid for certain drugs exceeded the quantity available to dispense to Medicaid recipients from January 1, 1999 through March 24, 2000, which also resulted in an alleged overpayment to PROVIDER. To resolve the audit, AHCA initially sought recoupment of a total overpayment in the amount of $977,883.08. In response to the audit letter dated April 6, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 01-1966. 4. Subsequent to the original audit and in preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result, AHCA determined that the alleged total overpayment should be adjusted to $506,064.60. After further review of additional documentation, the overpayment was adjusted to $247,574.31, with an investigative cost assessment of $22,000.00, for a total of $269,574.31. In the interest of settling this matter as expeditiously and economically as possible, PROVIDER is not challenging the cost assessment. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment and investigative costs issues arising from the MPI review and re- reviews. Lincourt Pharmacy Settlement Agreement (2) Within thirty (30) days of receipt of entry of the Final Order, PROVIDER agrees to make a lump sum payment of one hundred thousand dollars ($100,000.00) and the balance of one hundred sixty nine thousand five hundred seventy four dollars and thirty one cents ($169,574.31) for a total of two hundred sixty nine thousand five hundred seventy four dollars and thirty one cents ($269,574.31) plus 10% interest per year to be made in six (6) equal monthly payments, as set forth in the Amortization Schedule attached hereto as Exhibit “B”, in full and complete settlement of the administrative dispute under the audit referenced C.I. No. 00-1061-000-3/H/GWM and in connection with the proceedings before the Division of Administrative Hearings (DOAH Case No. 01- 1966). No pre-payment penalty shall apply should PROVIDER make accelerated payments to be applied to the principal balance of $169,574.31. (3) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case, without either party conceding their position and will completely release both parties from all administrative liabilities arising from the findings in the audit referenced as C.I. No. 00-1061-000-3/H/GWM. PROVIDER and AHCA agree that full payment as set forth above will release both parties from any and all civil claims, demands, and liabilities, whether arising in law or equity, contract, or statute, arising from the findings in the audit referenced as C.I. No. 00-1061-000-3/H/GWM. Lincourt Pharmacy Settlement Agreement 7. (4) PROVIDER agrees that it will not rebill the Medicaid Program in any mnanner for claims that were not covered by Medicaid, which are the subject of the audit in this case. AHCA retains the right to perform a 6-month follow-up review. PROVIDER does not waive any rights under the laws of the State of Florida, the duly promulgated and published Rules of the Medicaid program, and all other applicable rules and regulations, including the right to challenge the findings of any follow-up review or audit. (5) The parties agree this settlement represents no finding concerning intentional fraud or abuse of the Medicaid program, but is rather a method of settling the administrative dispute between them. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 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. 8. AHCA and PROVIDER each reserves the right to enforce this Agreement under the laws of the State of Florida, the duly promulgated and published Rules of the Medicaid Program, and all other applicable rules and regulations. 9. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. Moreover, this Agreement shall not be construed as an admission, finding or acknowledgment that PROVIDER, its predecessors, Lincourt Pharmacy Settlement Agreement successors, officers, directors, managers, owners, or employees knew, or should have known, acted in deliberate ignorance of, or acted with deliberate disregard for the truth or falsity of any claims or other data AHCA may maintain as support for its overpayment allegations set forth in either the audit referenced as C.I. No. 00-1061-000-3/H/GWM or any of its communications or pleadings in this administrative matter. 10. Each party shall bear its own attorneys’ fees and costs, if any. 11. 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. 12. 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. 13. This Agreement constitutes the entire agreement between PROVIDER and AHCA, and shall inure to the benefit of PROVIDER’s predecessors, successors, officers, directors, managers, owners and employees concerning all matters, and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between 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. 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. Lincourt Pharmacy Settlement Agreement 15. 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 all issues raised 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. 16. | 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. 17. To the extent that any provision of this Agreement is determined by a court of competent jurisdiction to be unenforceable or otherwise prohibited by law for any reason, such provision shall be effective only to the extent it is enforceable or otherwise not prohibited, and such enforceability or 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 predecessors, successors, assigns, heirs, administrators, representatives and trustees; payment of the amounts due under this Agreement are solely the responsibility of the PROVIDER named as Petitioner. 19. All times stated herein are of the essence of this Agreement. Lincourt Pharmacy Settlement Agreement 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. LINCOURT PHARMACY Dated: 7 Ay , 2004 BY: ~ LOUIS F. F. LADSON, JR. ITs: Ga AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 es, Dated: LRT 1], 2004 Janfés D. Boyd Inspector General iN 4, Al hk §s Dated: Hil, J 2004 Valda Clark Christian Z Yi Counsel Mo- F— Dated: 4/ v- , 2004 L. Wi Porter IT Assistant General Counsel vavees Ub AUG L000 FAA OLoeeutDuL Pn es 7 2916 E t ‘gui STATE OF FLORIDA rye iy ’ ty ED GENCY FOR HEALTH CARE ADMINISTRATION 9 2 Py JGB BUSH, GOVERNOR auaen ». Kinase iy ij Lepage f: 3/ F NE I pe April 6, 2001 ARMA r lye Wg TL CERTZFIED MAID - RETURN RECEZET : 7000 0600 0023 5447 a provider No. 1020099 00 License No. pHo008725 Louis Ladson, R.Ph., Pharmacy Manager REC FIVE D Aya Lincourt Phaxmacy, Inc. . 501 South Lincoln Avenve . Clearwater, Florida 33756 . APR 24 2001 MEDICAID PROGRAM Rt FINAL AGENCY AUDIT REPORT INTEGRITY C.I. No, 00-1061-000-3/H/GWi Dear Mr. Ladson: An on-site audit of your pharmacy was initiated on May 30, 2000. Tha Florida Medicaid Program through the Agency for Health Care Administration has determined that you have been overpaid $977,883.08 in connection with claims submitted to Medicaid during the audit period(s) specified. This conclusion is supported by -the audit results. . This review and the geterminations were made in accor@ance with the provisions of Chapter 409, Florida Statutes (F.S.), and . Chapter $9G, Florida Administrative Code (F.A.C.). In applying for Medicaid reimbursement, providers are required to follow the applicable statutes, rules. Medicaid provider handbooks, statements of Medicaid policy, and federal laws and regulations. Medicaid cannot properly pay for claims that do not meet Medicaid requixements. When a provider receives payment in violation of these provisions, those funds must be repaid. REVIEW DETERMINATIONS The audit included a judgmental sample yeview and a separate statistical analysis of a random sampling with the results applied to tha random sample universe of claims submitted during the audit period. The audit period for this review was from September 28, 1998, through March 24, 2000. - This review identified an overpayment of 977,983.08. The actual overpayment was calculated using 4 procedure that has been proven valid an@ is deemed admissible in administrative and law courts as evidence of the overpayment - Attached are the overpayment calculations, a 2727 Mohan Drive © Mail Stop F G Tatiehassec. FL 32308 x, a iteers! Visir ANCA Online at MF www.fdkasrate fi.us / XHIBIT "AT al OD vas Lincourt Pharmacy Page 2 gummary of documented discrepancies, and an itemized listing of discrepancies noted in the review of the judgmental and xrandem sample. The audit also included a comparison of your lawful documented product acquisitions with your paid Medicaid claims. The audit period for this review was from January 1, 1999, through , on March 24, 2000. The drug quantity billed to Medicaid, in many... instances, exceeded the quantity available to dispense to Medicaid’ recipients. This review identified an overpayment of $847,889.44. Attached are the overpayment calculations. Accordingly, we have determined at this time that you have been overpaid by the Medicaid program in the amount of $977,883.08: If you accept or concur with these findings, please send your check in the amount of $977,883.08, for the identified overpayment, made payable to the ¥Ylorida Agency for Health Cara Administration, to: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 (Note: The check mst be payable to the Florida Agency for Health Care Administration, not to any employee of the agency.) ‘to ensura proper credit, be sure that your provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens ‘ at (B50) 487-4298. , You have the right to request a formal or informal hearing * pursuant to section 120.569, F.S. If a petition for formal hearing is made, the petition must be made in compliance with gule section 28-106.201, F.A.C. Please note that rule section 28-106.201(2), F.A.C.. spacifies 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 addyvesa: Mr. Charles G. Ginn, Chief Medicaid Program Integrity Office of the Inapector General Agency for Health Care Administration 2727 Mahan Drive, Mail Stop # 6 REC EIVED Tallahassee, Florida 32308-5403 APR 2 4 2001 = MEDICAID PROG 7AM INTeGra FY wevas Lincourt Pharmacy Page 3 , De not send requests oF petitions to sny other address. if a heaxing request im 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 willbe due and payable at the end of that .2i-day period. TLE carmen eae Any questions that you may have ragaxding this matter should be directed to: Gary W. Marsh, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403. telephone number (850) 922-4374. 050 Sincerely. IL. _ bp. Kenneth Yon Program Administrator Medicaid Program Integrity DKY /gwm Attachment (5) ce; Medicaid Program Integrity Administrative Section Medicaid Accounts Receivable, Attn: Willie Bivens Beritage Information Systems, Inc. ' Medicaid Program Development Area Medicaid office : Heritage Final Let Lincaurt.doc 01/0} sce AA: DRSTRNANNNNA SA AGENCY FOR HEALTH CARE ADMINISTRATION AMORTIZATION SCHEDULE LINCOURT PHARMACY/Provider # 1020089-00/C. 1. # 00-1061-000 LOAN DATA Past Due Balance:|$269,574.31 Table starts at date: 6/1/2004 Annual int rate: or payment number: 1 Term in years: Payments per year: First payment due:|6/1/2004 CALCULATED PAYMENT Entered payment: Calculated payment:|$46,248.54 Monthly Pmt Used: [$46,248.54 $269,574.31 1st Pmt in Table: 1 Cumulative interest prior to payment 1: $0.00 Table es] amet | SGOT Te | inc | saamte | mst” | aout | Po Due Date Balance pa Balance Interest Amount Paid 4 6/1/2004 269,574.31 2,246.45 | 44,002.09 | 225,572.22 2,246.45 | 4624854 | si 2 71112004 225,572.22 1,879.77 | 44,368.78 181,203.44 4,126.22 [| 4624854 | | 3 8/4/2004 181,203.44 1,510.03 | 44,738.52 136,464.93 5,636.25 9/1/2004 136,464.93 1,137.21 45,111.34 91,353.59 6,773.46 10/1/2004 91,353.59 761.28 45,487.26 45,866.33 7,534.74 14/1/2004 45,866.33 382.22 45,866.33 0.00 7,916.96 [0.00 | y__0.00__ [0.00 | |__0.00 | [0.00 | [0.00 | [0.00 [900 fT [ooo | ooo [| [000 0.00 | Pd Pd Page 1 of 1

Docket for Case No: 01-001966