FILED ANC! STATE OF FLORIDA RCENCY CLERK AGENCY FOR HEALTH CARE ADMINISTRATION Z ‘ Tas Just 22D 5 FOUNDATION HEALTH PLAN, 0, b, ~“&S Petitioner, Pe Oe rs) : o vs. DOAH CASENOs.: 01-215724,-. 7 through 01-2163 RENDITION NO.: AHCA- 02-0144 ~MDO % STATE OF FLORIDA, AGENCY CA ‘toed FOR HEALTH CARE ( ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement which is attached and incorporated herein by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based upon the foregoing, this petition is dismissed and the file is closed. cy DONE AND ORDERED on this l¢ day of _{ n ‘Ul He , 2002, in Tallahassee, Florida. Rhonda Medows, 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, 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 OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. Copies Furnished to: Claude Arrington Charles Ginn/Jenie Stokes Administrative Law Judge Medicaid Program Integrity DOAH AHCA 1230 Apalachee Parkway 2727 Mahan Drive Tallahassee, FL 32399-3060 Tallahassee, FL 32308 Steven Grigas, Esquire Willie Bivens AHCA, Bldg. #3 AHCA Finance & Accounting 2727 Mahan Drive 2727 Mahan Drive Tallahassee, FL 32308 Tallahassee, FL 32308 Michael Comerford, Tracy Schmidt Foundation Health Plan. 1340 Concord Terrace Sunrise, Fl 33322 CERTIFICATE OF SERVICE LHEREBY 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 y < day of uo, 200¢. Grater, Agency Clerk State of Florida Agency for Health Care Administration STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS FOUNDATION HEALTH PLAN, / ! 2, Petitioner, / Case Nos. 01-2157 < / through 01-2163 vs. / / AGENCY FOR HEALTH / CARE ADMINISTRATION, / / Respondent. / / SETTLEMENT STIPULATION AND RELEASE This Settlement Stipulation and Release (“Stipulation”) effective as of September 20, 2001 ("the Settlement Date"), is made and entered into by and among Foundation Health Plan (a/k/a, Foundation Health, a Florida Health Plan, Inc.) (“Foundation”), and the Agency for Health Care Administration (the “Agency”) (Foundation and the Agency are referred to collectively as the “Parties”) with reference to the following facts: A. On or about January 12, 2001, the Agency issued audit reports C.I. No. 00-1970-029/JMS through C.I. No. 00-1970-035/JMS (“Audit Reports”) whereby the Medicaid Program Integrity Office reviewed payments to Foundation for the period January 1, 1999 through June 30, 2000 and found certain capitation payments were made to Foundation on behalf of Medicaid recipients who were not eligible for HMO services during the months covered by the payments according to the Agency’s Medicaid Management Information System files. B. On or about May 7, 2001, Foundation submitted to the Agency documentation confirming the payment of fee-for-service claims to providers of service for Medicaid recipients who were MIA 236791-2.038215.0036 not eligible for HMO services during the months covered by the payments according to the Audit Reports and the Agency made a determination to not collect, from Foundation, the capitation payments made to Foundation on behalf of those Medicaid recipients. Cc. On or about May 9, 1999, Foundation filed a formal request for a hearing in the State of Florida Division of Administrative Hearings entitled Foundation Health Plan vs. Agency for Health Care Administration, Case Nos. 01-2157 through 01-2163 (the “Action”). D. On or about July 20, 2001 and August 3, 2001, Foundation submitted additional documentation to the Agency confirming the payment of capitated claims to providers of service for Medicaid recipients who were not eligible for HMO services during the months covered by the payments according to the Audit Reports and the Agency made a determination to not collect, from Foundation, the capitation payments made to Foundation on behalf of those Medicaid recipients. E. On or about September 7, 2001, the Agency issued Amended Final Agency Reports for C.L No. 00-1970-029 through C.I. No. 00-1970-035 issuing a credit, thus reducing the final overpayment total, for those Medicaid recipients who were not eligible for HMO services during the months covered by the payments according to the Audit Reports, but for whom Foundation produced documentation substantiating the payment of claims to providers of service, as set forth in paragraphs B and D of this Stipulation. F. The Parties enter into this Stipulation and by so doing the Parties seek and intend to fully, completely, and finally resolve and terminate all disputes, claims, and actions arising from or related in any way to the facts alleged in the Action, including but not limited to those claims which were actually asserted or which could have been asserted in the Action, and to preclude the possibility of further disputes between them arising out of or in any way related to the facts MIA 236791-2.038215.0036 alleged in the Action. WHEREFORE, in consideration of the promises, covenants, warranties, and representations set forth below, the Parties agree as follows: 1. Payment by Foundation On or before thirty days from the date on which Foundation receives from the Agency, a fully executed copy of this Stipulation, Foundation shall pay to AHCA by check the total sum of $2,158.75. 2. Stipulation to Order of Dismissal The Parties shall file with the Division of Administrative Hearings this Stipulation and an Order of Dismissal which will, among other things, satisfy AHCA’s Amended Final Agency Audit Reports C.I. No. 00-1970-029/JMS through C.I. No. 00-1970-035/JMS as issued September 7, 2001. 3. Release by Foundation Upon the execution of this Stipulation by the Agency, Foundation for itself, its representatives, assigns and heirs, and anyone claiming through Foundation, hereby releases and discharges the Agency from any and all claims or demands as may be related to audit reports C.I. No. 00-1970-029/JMS through C.I No. 00-1970-035/JMS. 4. Release by Agency Upon the execution of this Stipulation and in consideration of the sum of Two Thousand One Hundred and Fifty eight Dollars and Seventy Five Cents ($2,158.75), the Agency for itself, its representatives, assigns and heirs, and anyone claiming through the Agency, hereby releases and discharges Foundation and, its agents, officers, employees, and its former parent corporation, MIA 236791-2.038215.0036 Health Net, Inc. from any and all claims or demands as may be related to audit reports C.I. No. 00-1970-029/JMS through C.I No. 00-1970-035/JMS. The Parties agree that this Stipulation may be executed in counterparts and will become effective immediately upon execution by all Parties, subject to exchange of signature pages. EXECUTED in multiple originals, each of equal dignity, on the dates as noted below. Mépermott, Will and Emery Health, a Flesi Chief, Medicaid Counsel / AHCA 2727 Mahan Drive, MLC #3 Tallahassee, FL 32308 [oh a Bob Sharpe Deputy Secretary for Medicaid AHCA 2727 Mahan Drive Tallahassee, FL 32308 Zbe [bhi William Roberts Acting General Counsel AHCA 2727 Mahan Drive Tallahassee, FL 32308 MIA 23679 1-2.038215.0036

Docket for Case No: 01-002157