Petitioner: PHYSICIANS ASSOCIATES
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: FLORENCE SNYDER RIVAS
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: Jul. 10, 2001
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, October 17, 2001.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA 3
AGENCY FOR HEALTH CARE ADMINISTRATION
PHYSICIANS ASSOCIATES, P.A.,
Petitioner,
v.
AHCA Provider No. 370247200
STATE OF FLORIDA, C.I1. 97-0610-000 4 y
AGENCY FOR HEALTH CARE DOAH Case No. 01-2697 as kK ( werat ne
ADMINISTRATION, RENDITION NO.: AHCA-03-0383-S-MDO
Respondent. a
/
FINAL ORDER
THE PARTIES resolved all disputed issues and executed a settlement agreement
which is attached and 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 9 dayof _-J1e42____, 2003, in
Tallahassee, Florida.
Lfukt A
ia Rhonda. Medows, MD, Secretary
I
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:
Moises Grayson, Esquire
Blaxberg, Grayson, Kukoff & Segal, P.A.
25 SE 2" Avenue, Suite 730
Miami, Florida 33131
Susan Felker-Little, Esquire
Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #3
Tallahassee, Florida 32308-5403
F.S. Rivas
Administrative Law Judge
The Desoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Timothy Byrnes, Bureau Chief of MPI
Agency for Health Care Administration
2002 Old St. Augustine Road, Bldg. D
Tallahassee, Florida 32301
Finance and Accounting
2727 Mahan Drive, Mail Stop #14
Tallahassee, Florida 32308
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been
furnished to the above named addresses by U.S. Mail on this the [ i day of
f wLetiG@__, 2003.
(« Rt I a
4 Chara 7 DOM pt)
\a Lealand McCharen, Agency Cler
Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #3
Tallahassee, Florida 32308-5403
(850) 922-5873
STATE OF FLORIDA “ fe
AGENCY FOR HEALTH CARE ADMINISTRATION -7- Dp :
PHYSICIANS ASSOCIATES, P.A.,
Petitioner,
vy.
AHCA Provider No. 370247200
STATE OF FLORIDA, C.L. 97-0610-000
AGENCY FOR HEALTH CARE DOAH Case No. 01-2697
ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and PHYSICIANS ASSOCIATES, P.A.(“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 avoiding the
costs and burdens of litigation.
2. PROVIDER is a Medicaid provider in the State of Florida, with provider number
370247200.
3. In its final agency audit report dated April 19, 2001, AHCA notified PROVIDER
that a review of Medicaid claims, performed by Medicaid Program Integrity (MPI), indicated
hat, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency
sought overpayment in the amount of $23,009.91. In response to the final agency audit report.
PROVIDER filed a petition for a formal administrative hearing and the matter was referred to
the Division of Administrative Hearings (DOAH), and DOAH assigned the matter DOAH Case
0. 01-2697.
4. Thereafter, the parties agreed to remand the matter to the Agency so the Agency
could perform a review of additional information from Petitioner related to the disputed claims.
The review of additional information resulted in an adjustment to the overpayment
determination.
5. In order to resolve this matter without further administrative proceedings,
PROVIDER and AHCA expressly agree as follows:
(a) AHCA agrees to accept the payment set forth herein in settlement of the
overpayment issues and investigation costs arising from the MPI review.
(b) PROVIDER agrees to make a single payment, within thirty (30) days of
receipt of the Agency for Health Care Administration Final Order incorporating by reference this
Settlement Agreement, in the amount of SEVENTEEN THOUSAND DOLLARS AND NO
($17,000.00).
(c) The single payment of $17,000.00 shall be made payable and remitted to:
Agency for Heaith Care Administration
Attn. Medicaid Accounts Receivable
P. O. Box 13749
Tallahassee, FL 32317-3749
in full and complete settlement of all claims in the audit referenced as C.I. 97-0610-000.
Payment shall clearly indicate that it is pursuant to a settlement agreement and shall
reference C.I. No. 97-0610-000 and Provider No. 370247200.
(d) 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 C.]. 97-0610-000.
(e) PROVIDER is responsible for ensuring timely delivery of the payment set
forth herein. Furthermore, failure to timely make the payment will render the balance due and
i)
payable immediately, with statutory 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.
() PROVIDER agrees that it will not rebill the Medicaid Program in any
manner for claims that were not covered by Medicaid, which were the subject of the audit in this
case.
(g) PROVIDER will cooperate in a comprehensive follow-up review to
ensure that PROVIDER is billing Medicaid correctly.
6. 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.
7. AHCA reserves the right to enforce this Agreement under the laws of the
State of Florida, the Rules of the Medicaid Program, and all other applicable rules and
regulations.
8. This settlement does not constitute an admission of wrongdoing or error by either
party with respect to this case or any other matter.
9. The parties agree to bear their own attorney’s fees and costs, if any, except as
hereinabove stated.
10. 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.
11. 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.
Lee)
12. This Agreement constitutes the entire agreement between PROVIDER 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 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.
13. 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.
14. 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 that is
consistent with the terrns of this settlement 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.
15. 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.
16. 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.
17. This Agreement shail inure *o the benefit of and be binding on each party’s
successors, assigns, heirs, administrators, representatives and trustees.
18, All times stated herein are of the essence of this Agreement.
19. This Agreement shall be in full force and effect upon execution by the respective
parties in counterpart.
PROVIDER:
PHYSICIANS ASSOCIATES, P.A.
wetin K dage
By Jcun K gee
(print name above)
Its: SECKETARKY
(print title above)
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
(a a LWRY plot Ae
RUFUS OBLE
Inspector General
Lab LL GE
VALDA CLARK CHRISTIAN
General Counsel
QA Ite
SUSAN C. FELKER-LITTLE
Assistant General Counsel
Mtg/documents/38
Dated? AFA LF , 2003
Dated: fom GF 2003.
Dated: Ap 2% _,2003.
Docket for Case No: 01-002697
Issue Date |
Proceedings |
Jun. 13, 2003 |
Final Order filed.
|
Oct. 17, 2001 |
Order Closing File issued. CASE CLOSED.
|
Oct. 12, 2001 |
Agreed Motion to Remand Without Prejudice (filed by Respondent via facsimile).
|
Aug. 14, 2001 |
Order Granting Continuance and Re-scheduling Hearing issued (hearing set for October 19, 2001; 9:00 a.m.; Miami, FL).
|
Aug. 13, 2001 |
Motion for Continuance of Hearing and Motion for Live Hearing as Opposed to Video Teleconference (filed by Petitioner via facsimile).
|
Aug. 13, 2001 |
Physicians Associates, P.A. Response to and Motion for Protective Order from the Agency for Healthcare Administration`s First Interrogatories to Petitioner (filed via facsimile).
|
Aug. 13, 2001 |
Physicians Associates, P.A. Response to and Motion to Strike the Agency for Healthcare Administrations First Request for Admissions (filed via facsimile).
|
Aug. 13, 2001 |
Physicians Associates, P.A. Response to and Objections to the Agency for Healthcare Administration`s First Request for Production of Documents (filed via facsimile).
|
Jul. 30, 2001 |
Order of Pre-hearing Instructions issued.
|
Jul. 30, 2001 |
Notice of Hearing by Video Teleconference issued (video hearing set for October 5, 2001; 9:00 a.m.; Miami and Tallahassee, FL).
|
Jul. 25, 2001 |
Respondent`s Unilateral Response to Initial Order (filed via facsimile).
|
Jul. 13, 2001 |
Respondent`s First Request for Production of Documents filed.
|
Jul. 13, 2001 |
Respondent`s First Request for Admissions filed.
|
Jul. 13, 2001 |
Notice of Service of Respondent`s First Interrogatories to Petitioner; Respondent`s First Request for Admissions; and Respondent`s First Request to Produce filed.
|
Jul. 11, 2001 |
Initial Order issued.
|
Jul. 10, 2001 |
Petition for Hearing to Review Final Agency Action filed.
|
Jul. 10, 2001 |
Final Agency Audit Report filed.
|
Jul. 10, 2001 |
Notice (of Agency referral) filed.
|