FILED P7325 02 STATE OF FLORIDA ; AGENCY FOR HEATH CARE ADMINISTRATION AHCA DEPARTMENT CLERK TREASURE ISLE CARE CENTER, FIRST COAST HEALTH & REHABILITATION, FIRST COAST HEALTH & REHABILITATION - S CENTER, and UNICARE HEALTH FACILITIES d/b/a — TREASURE ISLE NURSING HOME, ba S Petitioners, en a ww vs. DOAH CASE NOS. 01-2167, | 01-2168, 01-2170, 01-2171 eLovsol RENDITION NO.: AHCA-02- —S-MDO AGENCY FOR HEALTH CARE 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 “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the / kK day of a . CoG, , 2002, in Tallahassee, Florida. pepe _ Rhénda J. Medows, M.D., Secretary Agency for Health Care Administration a a eae CRSA ERE TEREST nee ROR ORT T-TREE RET PE “= BY THIS FINAL ORDER IS A PARTY WHO IS ADVERSELY AFFECTS ENTITLED TO A JUDICIAL REVIEW Wit: SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALCNC WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE D ICT 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: R.L. Caleen, Jr. 1725 Mahan Dr. Suite 201 Tallahassee, FL 32317-5828 Kelly Bennett, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Harry L. Hooper Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and Accounting Robert V. Peirce, Medicaid Program Integrity Se ne I remem meme oo Sree mame compremee ne JA A A A A Rl ie ee Se ee ere CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and corvech copy of the foregoing has been furnished to the above med addressees by ‘U.S. Mail on this the uv day of whe , 2002. Marre Agenéy Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 wren doa F F E F creme Her Ot a ee STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS TREASURE ISLE CARE CENTER, FIRST COAST HEALTH & REHABILITATION, eS FIRST COAST HEALTH & REHABILITATION CENTER, and UNICARE HEALTH FACILITIES d/b/a TREASURE ISLE NURSING HOME, 2 m3 2 Q Petitioners, ra 2 v. DOAH CASE NOS. 01-2167, 01-2168 01-2170, 01-2171 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT This settlement agreement (“Agreement”) is entered into by and between the Agency for Health Care Administration (“AHCA”), and Treasure Isle Care Center, First Coast Health & Rehabilitation, First Coast Health & Rehabilitation Center, and Unicare Health Facilities D/B/A Treasure Isle Nursing Home. (“Petitioner”) 1. This matter arises out of AHCA’s review of Petitioner’s paid claims to Medicaid for the period of time between January 1, 1999 and June 30, 2000. On April 9 and April 12, 2001, AHCA issued four Final Agency Action Letters (FAAL) that determined Petitioner had been overpaid by Medicaid. The total amount of overpayment sought by AHCA was $594,883.57. 2. Petitioner filed petitions challenging AHCA’s determination and requesting formal administrative hearings. The four cases were consolidated for hearing. Re em ae TERR SEE OEE OE Me RRR FREE RTE SRS NET NNR: “CER RRR ee Settlement Agreement Treasure Isle/First Coast Cases Page 2 of 6 3. The parties agree that the Ic eligibility issue will not be pursued in the present matter and that AHCA does not waive its right to seek repayment of the per diem payments based upon lack of ICP eligibility for the subject recipients or any other recipients of Petitioner's facility. However the parties agree that should AHCA seek such repayment, Petitioner does not waive any defenses it may have. | 4. As a part of trial preparation, the parties have engaged in extensive document review. Subsequent to issuance of the FAAL, Petitioner supplied additional documentation that AHCA has reviewed and concludes that many of the recipients were in fact eligible for prior authorization but that Petitioner failed to request such authorization. 5. Petitioner agrees that prior authorization is required prior to billing Medicaid for the H Supplement, and that its actions in failing to obtain prior authorization did not comport to the clear and unambiguous Medicaid billing requirements. 6. Based upon the subsequent documentation, the adjusted overpayment amount is $174,390.90. In order to resolve this matter without further administrative proceedings, Petitioner has agreed to repay the adjusted overpayment ($174,390.90) and has offered to pay for a portion of AHCA’s investigation costs ($6,000). 7. In total, Petitioner offered to repay $180,390.90. AHCA has agreed to accept this amount as full payment with regard to the four audits, in the manner set forth herein. 8. Petitioner agrees to pay to AHCA, on or before January 31, 2002, the sum of one- hundred eighty thousand three-hundred ninety dollars and ninety cents ($180,390.90) to be made in one lump sum payment as full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case Nos. 01-2167, 01-2168, 01-2170, and 01- 2171). arr PRR SRN RI ra SC ETE RET ORE ORE EE RE OTR TCR NR ETE Tae Settlement Agreement Treasure [sle/First Coast Cases Page 3 of 6 9. Petitioner is responsible for ensuring timely delivery of the payment. F urthermore, failure to timely make the payment will render the balance due and payable immediately, with interest, and interest will continue to accrue until the entire balance is paid. AHCA reserves the right to. seek enforcement of this agreement by any legal means. 10. Petitioner and AHCA agree that full payment as set forth above will resolve and settle these cases completely and release both parties from all liabilities arising from the findings in the audits referenced as: C.I. 00-1497-019, C.I. 00-1497-020, C.I. 00-1497-057, and CL 00-1497- 058, except for the ICP issue which may be raised by AHCA via another audit. 11. Petitioner 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. 12. Petitioner agrees that failure to make payment per the terms of this agreement may result in the Agency pursuing all legal means to enforce this agreement and may include a request for attorney fees and all costs associated with the enforcement of this agreement. 13. Payment shall be made payable to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the C.I. Number. HOWEVER, payment shall be delivered to: Kelly A. Bennett, Assistant General Counsel (to ensure timely cancellation of the hearing in this matter). ere FORT RR ESR RE RR REE RR RR © Settlement Agreement Treasure Isle/First Coast Cases Page 4 of 6 14. Upon complete execution of this Agreement by Petitioner, and partial execution by AHCA (minimally, execution by counsel for AHCA), this Agreement constitutes Petitioner’s dismissal of the petition and authorizes AHCA to file a Motion to Relinquish Jurisdiction with the Division of Administrative Hearings. 15. .. Immediately upon receipt of an Order from the Division of Administrative Hearings that relinquishes jurisdiction to AHCA, the Agreement and a Final Order will be processed. 16. Except as expressly set forth in this agreement, the parties will bear their own fees and costs associated with these proceedings. 17. Petitioner, for itself and for its attorneys, heirs, executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and AHCA’s actions herein, including but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Petitioner. 18. 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. Furthermore, Petitioner agrees that its signature alone binds it to make the payment as set forth in this agreement. The parties further agree that a facsimile or photocopy reproduction of this agreement with Petitioner’s signature alone shall be sufficient for the Agency to enforce the agreement and to cancel the hearing in this matter. 19. 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. EEE EEE EERE TR PRET EE RRR NR eR Fe Settlement Agreement Treasure Isle/First Coast Cases Page 5 of 6 20. In the event Petitioner breaches this Agreement, and enforcement of this Agreement or recovery of damages for breach hereof is obtained by law or by legal proceedings through an attomey at law, all costs of collection or enforcement, including reasonable attorneys’ fees and - costs, shall be paid by Petitioner to AHCA. 21. This Agreement constitutes the entire agreement between Petitioner and 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 or agreements between Petitioner 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. . 22. Petitioner 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. Petitioner further agrees that the Agency should issue a Final Order which is consistent with the terms of this settlement, that adopts this agreement and closes this matter. However, if for any reason AHCA does not adopt this agreement, Petitioner reserves the right to re-open this matter with the Division of Administrative Hearings. 23. 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. 24. 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. CTR CS OTR SRE TTR SE Pr remem me re rg SOR RRR RRR RT RR or er ORE rere em or Settlement Agreement Treasure Isle/First Coast Cases Page 6 of 6 25. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. TREASURE ISLE CARE CENTER, FIRST COAST HEALTH & REHABILITATION, FIRST COAST HEALTH & REHABILITATION. CENTER, and UNICARE HEALTH FACILITIES d/b/a TREASURE ISLE NURSING HOME Vila Nba) Dated: fain EF 2002 LaRae Nelson, Vice President ( Extendicare Health Services, Inc. Reimbursement Division 111 West Michigan Avenue Milwaukee, WI 53203 R. L. Caleen, Jr. Esq y Attomey for Petitioner AGENCY FOR HEALTH CARE As former owner/operator of Petitioner/Provider ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Dated: a. / L , 2002 Tallahassee, FL 32308-5403 VA , Dated: A Y , 2002 Rufus Noble Inspector General WiC Dated: ale , 2002 William Roberts Acting General Counsel Dated: / 2002 Assistant General Counsel rere were! a sr sever

Docket for Case No: 01-002170MPI