STATE OF FLORIDA FILE AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION COMMCARE PHARMACY, INC., DEPUTY CLERK Petitioner, M m /)- “losa OG Sond CASE NO. 01-2172 PROVIDER NO. 103994600 STATE OF FLORIDA, AUDIT C.I. NO. 00-0955-000-3 AGENCY FOR HEALTH CARE Rendition No. AHCA-04-062S-MBO ADMINISTRATION, TAL oS vs. Respondent. / FINAL ORDER Gil id Of 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. dh DONE and ORDERED on this the Yb ‘day of TA ieuroeeg , 2004 in Tallahassee, Florida. Mavlef fi Rhonda Medows, MD, 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 I], Esquire Agency for Health Care Administration (Interoffice Mail) James. M. Barclay, Esquire Ruden, McClosky, Smith, Schuster & Russell, P.A. 215 S. Monroe Street, Suite 815 Tallahassee, Florida 32301 (U.S. Mail) Michael Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity 4 JoAnn Jackson ledicaid Program Integrityc’ \ John Hoover, Finance and Accounting CERTIFICATE OF SERVICE 1 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 OQday of den ICE uf ; 2004 qolaabial McCharen, a -) (TOE ene Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 LONBASINIUIpPY 2329 Yeap 30) Aquaby STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS [002 2} 250 TaSNNDD TWuANID COMMCARE PHARMACY, INC, Q3SAIW034Y Petitioner, DOAH CASE NO: 01-2172 Vv. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Commeare Pharmacy, Inc. (“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 resolving the disputes between them and avoiding the costs, burdens, and uncertainties of further litigation. Neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 103994600 and was a provider during the audit period. 3. Pursuant to its final agency audit report (the “Final Agency Action”), dated April 9, 2001, AHCA alleged that the Medicaid Program had paid PROVIDER $754,330.00 to which it was not entitled during a seventeen (17) month period, J uly 24, 1998 through January 21, 2000 (the “Audit Period”). In response to the audit letter dated April 9, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 01-2172. TAL:46021:1 _ COMMCARE PHARMACY, INC. SETTLEMENT AGREEMENT 4. Subsequent to this Final Agency Action, PROVIDER forwarded large volumes of documentation (on multiple occasions) to the AHCA for additional review. After those reviews, the final agency calculation of the alleged overpayment was adjusted to $143,069.00 for prescription review violations and $134,012.00 in inventory shortage violations, a total alleged overpayment of $277,081.00 (a $477,249.00 adjustment in the amount of this alleged overpayment). After being notified of these adjustments, the PROVIDER obtained further documentation from duly licensed and authorized pharmaceutical suppliers, which also was submitted to AHCA for its review. As a result of these multiple re-reviews and adjustments, AHCA’s current position is that the amount of this alleged overpayment should be again adjusted to $27,729.81. In addition, AHCA is seeking to have the PROVIDER reimburse the government its costs associated with this appeal; which, in the interests of settling this matter as expeditiously and economically as possible, the PROVIDER is not challenging. 5. Given the adjusted overpayment amounts, and in order to resolve this manner as expeditiously and economically as possible, PROVIDER and the AHCA expressly agree as follows: (1) AHCA agrees to accept the payment set forth herein in settlement of the alleged overpayment issues arising from the MPI review. (2) Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of twenty seven thousand seven hundred twenty nine dollars and eighty one cents ($27,729.81) for the overpayment plus fifteen thousand dollars ($15,000.00) for investigative costs for a total of forty two thousand seven hundred twenty nine dollars and eighty one cents ($42,729.81) in full and complete settlement of all claims in the TAL:46021:1 2 COMMCARE PHARMACY, INC. SETTLEMENT AGREEMENT proceedings before the Division of Administrative Hearings (DOAH Case No. 01-2172). AHCA retains the right to perform a 6-month follow-up review under the Florida Statutes as of the date of the review. (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 liabilities arising from the findings in the audit referenced as CI. 00-0955- 000-3. (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. 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 7. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Settlement Agreement shall constitute PROVIDER’S authorization for the Agency, to withhold the total remaining amount due under the terms of this Settlement Agreement from any monies due and owing to PROVIDER for any Medicaid claims. 8. Each party reserves the right to enforce this Settlement 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. TAL:46021:1 3 COMMCARE PHARMACY, INC. SETTLEMENT AGREEMENT 9. This Settlement Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. Moreover, this Settlement Agreement shall not be construed as an admission of, evidence of or acknowledgment that PROVIDER, its officers, directors, managers, or employees knew, 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 support its overpayment allegations set forth in either the audit referenced as CI 00-0955-000-3 or its pleadings in this matter. 10. Each party shall bear its own attorneys’ fees and costs, if any. 11. The signatories to this Settlement Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Settlement Agreement on behalf of the respective parties. 12. This Settlement Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Settlement Agreement shall be in Leon County, Florida. 13. This Settlement 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 or 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 Settlement Agreement is completed and properly executed by both parties. TAL:46021:1 4 COMMCARE PHARMACY, INC. SETTLEMENT AGREEMENT 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. 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 tules 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 Settlement Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against either party as the originator, drafter or proponent of any provision hereto. 17. To the extent that any provision of this Settlement Agreement is determined bya court of competent jurisdiction to be unenforceable or otherwise prohibited by law, that provision shall be effective only to the extent it is enforceable or otherwise not prohibited, and such unenforceability or prohibition shall not affect any other provision of this Settlement Agreement. 18. This Settlement Agreement shall inure to the benefit of and be binding on each of the parties, as well as their successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence in this Settlement Agreement. TAL:46021:1 5 COMMCARE PHARMACY, INC. SETTLEMENT AGREEMENT 20. This Settlement Agreement shali be in full force and effect upon execution by the respective parties in counterpart. COMMCARE PHARMACY, INC. le Lnteald, Date: (24/02 Lombard’ BY: rint name) ITS: fro siceok THE AGENCY FOR HEALTH CARE ADMINISTRATION et — 7 date_//94/o4 ; 4 Acting Inspector General Sitee Lid CE Date: / LE Joey Valda Clark Christian General Counsel ‘ s a i oe [Zz ~[> -O3 L. Witiam Porter II Assistant General Counsel TAL:46021:1 6 * 9878476113710 FAX 3053728795 ZUCKERMAN SPAEDEK LLY queve { STATE OF FLORIDA e “Seéeident Gomméavé Pharmacy, Inc. 2817 East Oakland Park Blvd. Suite 301 © 33306 ida > AGENCY goin BaPORT _ 00-0955-000-3/H/IDI : th aré Administration hes determined that you have | “overpaid $754,330.00 in connection with claims submitted’ t' Medicaid during the audit period specified. This conclusio terminations were Wade in accorda e provisions “Of Chapter 409, Florida Statutes (F. S.J.: lapter 596,” Florida Administrative Code (F. A.C.). In Foe eee aeS Ara ea eae providers are Yequired t “fellow. the ites; Medicaid provider handb statem eg of onedicaid policy, and federal laws and. “Medicaid Cannot properly pay for claims that do not ~Medicaic requirements: When a provider receives pa i vis3ons « those funds must be repa SEvIEW DETERMINAT ons . whe é audit included a statistical analysis of a random ‘sampling, % “SCR the results applied to the random Sample universe ‘of claims ces submitted @uring the audit period. The audit period for thi : from July 24, 1938, through January 21, 2000. tified an overpayment | of $215,022.30. The ae 2727 Mahan Derive » Mail Stap #6 Gsbassee- FL 32308 05/04/01 13:10 FAX 3053729795 _ ZUCKERMAN SPABDEK Lu a : . Peter Lombardi, President ~ fhesaan® Page 2 of the overpayment . Attached are the overpay “s calculations, a summary of documented discrepancies, and an 2 itemized ‘listing of discrepancies noted in the review of the | yandom sample. rs product aéquisitions with your paid Medicaid claims. - The period for this review was from January 1, 1999, throw December 31, 1999. The drug quantity billed to Medicaid - instances, exceeded the qmantity available to dispens ;reci ipients. té you oe or concur with these ‘findings, please ‘Sena your _Sheck in the amount of $754,330.00, for the identified . a ayment, madé payable to the Florida Agency for Healt: ec h Care Administration i a Accounts Receivable iv) “?Po"ensure propex “Stedit, be sure that™ mactabet hr ad number is shown on your check. Questions ¥ding” payment” should be ‘directed to Ms. Willie” “429 8 eh You have the rig t to request a for Ps tO" oats on 120° 7569, F.s. ‘eas Dann ani hearing is m t the request ox petition must be x ' wenty-one (21) days “of receipt of this letter. timely request a hearing shall ‘be déemed a waiver oF: to. a hearing. 0576 4701 | is: 10 FAX 3053729795 ZUCKERMAN SPAEDEK LLP wave Peter Lombardi, President . . Page 3 27 2 ebsee caps oa : ee De cwtlen enw, © te . . : Ls 4 re It is important that a request for an informal hearing oO petition for a formal hearing be sant only to the folrlor address: Mr. Charles “Medicaid Program Integrity _ Of Eice of the Inspector General “Agency for Health Care Administration 2727 Mahan Drive, Mail Stop # 6 Tallahassee, ‘Florida 32308-5403 io Hot send véquests ‘Or “petitions to any other address : shearing request is not received within 21 days from the date of “veébipt of this letter, the right to such hearing is we : tit of the above-stipulated overpayment will.bBe ayepie at the end of that 21-day period. reO£f the eiSencee Gefieral, 2727 Mahan Drive, Mail oes # a ‘Pallahassee, Florida 32308-5403, telephone number (850) 9 L__prégram ‘Administra e Medicaid Program siete aearese : = eviiis eT ce sie : Program Ta ntegrity, See Section caid Accounts ‘Reééivable, Attn: Willie Bivens’ “est itage’ Information Systems, Inés : Medicaid Program Development, Pharmacy Services Besa Medicaid. Office Martin 1. "Ka ~ CNHeritage Audits\CommeareAAL

Docket for Case No: 01-002172MPI