sk a ke ba ol hs Aah ed a STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION KEY WEST CONVALESCENT CENTER, AND MARATHON ug 1A Ole le MANOR, Petitioner, CA cLicaco} vs. DOAH Case No. 01-2788 DOAH Case No. 01-2698 Audit No. 00-1497-038 Audit No. 00-1497-043 Rendition No. AHCA-@ -0010 -S- MDO AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved ali 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 Ph day of Jarnny 2008-th Tallahassee, Florida. 7 - Medows, MD, Secretary i Agency for Health Care Administration wer OR Ur acer ne oR rR ogee 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 Copies Furnished to: Peter A. Lewis, Esquire Goldsmith, Grout & Lewis, PA 307 West Park Avenue, Suite 200 Tallahassee, FL 32308 Kelly A. Bennett, Esquire Agency for Health Care Administration Mail Stop #3 (Interoffice Mail) Florence Snyder Rivas Administrative Law J udge Division of Administrative Hearings: The DeSoto Building : 1230 Apalachee Parkway . Tallahassee, Florida 32399-3060 Charlie Ginn, Chief Medicaid Program Integrity Agency for Health Care Administration Mail Stop #6 (Interoffice Mail) Finance & Accounting ee nen Ys gio dea lg veo ae CORRE ET Re reer er reer Fer epee mee rr” sae ke kb a: 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 £3 day of ita ce, 2002. - B) Chincle = TRA Wses> ' Virginia Daire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5865 i ei a ie eae oe "OPER NET” Smee STATE OF FLORIDA ! :... |: DIVISION OF ADMINISTRATIVE | HEARINGS N26 pe KEY WEST CONVALESCENT CENTER, AND MARATHON MANOR, é HGS Petitioners, CASE NO: ofa . provider no. 020775600 audit no. CI 00-1497-038 CASE NO: 01-2698 provider no. 020989900 audit no. CI 00-1497-043 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 Key West Convalescent Center and Marathon Manor (“Petitioners”): 1. This matter arises out of AHCA’s review of Petitioners’ paid claims to Medicaid for the period of time between January 1, 1999 and June 30, 2001. On April 9, 2001, AHCA issued Final Agency Action Letters (FAAL) that determined Petitioners had been overpaid by Medicaid in the amount of $44,545.86 (Key West) and $2,3 14.1 8 (Marathon Manor) for receiving H Supplements for several Medicaid Recipients for whom Petitioners had not received Prior Authorization nor had the recipient deemed eligible for an institutional care program (ICP eligible). . 2. Petitioners filed petitions challenging AHCA’s determination and requesting formal administrative hearings. The matters were ‘consolidated for final hearing, ror: PURO RIIE RE Re rR ETT E er ES pe ropers wile Le vob be ke Dec.13. 2901 O:02ANeL FaxteDU-dIS-251s Bec 12 "OL 15:53 No 59317020, 2 "Settlement Agreement DOAH Case No. 01-2788 Page 2 of 6 3, The parties agree that the 1cP eligibility issue will not bs pursued in the present matter and that AHCA does not waive its right to seek repayment of the Per diem poets upon lack of ICP eli gibility for the subject recipients or any other recipients of Petitioners! facility. However the parties agree that should AHCA seek such repayment, Petitioners doesinot waive any defenses if may have. ] 4. As a part of trial preparation, the parties have engaged in extensive document review and agree as follows: AHCA expressly agree as follows: | a. . Deleted by agreement of the parties after oxccution by Petitioner: Subsequent to issuance of the FAAL, Petitioners has supplied additional a documentation that AHCA has reviewed and concludes that several of the recipients were in fact eligible for prior authorization but that Petitioners failed to request such authorization. b. Prior authorization is required prior to billing Medicaid for the H Supplement, c. ‘Petitioner's actions in failing to obtain prior authorization did notlcomport to the clear and unambiguous Medicaid billing requirements. 5. Tn order to resolve this matter without further administrative proceedings, Pet itioners and ° The Petitioners submitted documentation that reguited i in an adjusted overpayment amount of $27, S21. 28, fer which Petitioners aeree tl Petitioners shall also pay $8,828.72 as payment to ANCA for a pation of its investi le an Hy al fees. Amended by agreement of the parties after execution by Poti soner ONS ee See coed OO RR RI MRI mR Boe ee Settlement Agreement DOAH Case No. 01-2788 , Page 3 of 6 d. In total, Petitioners agrees to pay $36,350.00 to AHCA. 6. AHCA agrees to accept $36,350.00, in the manner set forth herein in settlement of the overpayment issues arising from the MPI review. 7. ‘Petitioners agrees to pay to AHCA, on or before November 30, 2001, the sum of thirty- six thousand, three-hundred fifty dollars ($36,350.00) 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. 01-2788 and 01-2698). 8. Petitioners are responsible for ensuring timely delivery of the payment. Furthermore, 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. 9. Petitioners 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 audits referenced as: CI. CI 00-1497-038 and CI 00-1497-043, except for the ICP issue which may be raised by AHCA via another audit. 10. _ Petitioners 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. 11. Petitioners 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 attomey fees and all costs associated with the enforcement of this agreement. 12. Payment shall be made payable to: ee AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Settlement Agreement DOAH Case No. 01-2788 ', Page 4 of 6 And payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Numbers, and shall reference the C.I. Numbers. HOWEVER, payment shall be delivered to: Kelly A. Bennett, Assistant ’ General Counsel. 13. Upon complete execution of this Agreement by Petitioners this Agreement constitutes Petitioners’ dismissal of the petitions and authorizes AHCA to file a Motion to Relinquish Jurisdiction with the Division of Administrative Hearings. 14. 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. 15. Except as expressly set forth in this agreement, the parties will bear their own fees and costs associated with these proceedings. 16. Petitioners, for themselves and for their attorneys, heirs, executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys 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 Petitioners. 17. 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, — Petitioners agree that their signatures alone binds them to make the payment as set forth in this agreement. The parties further agree that a facsimile or photocopy reproduction of this agreement with Petitioners’ signature alone shall be sufficient for the Agency to enforce the agreement and to cancel the hearing in this matter. ch i ali, Settlement Agreement DOAH Case No. 01-2788 *, Page 5 of 6 18. 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. 19. nt of this Agreement or event either Party breaches this Agreement, and enfo. xe ry a 2\t aw or by legal proceedings through an de Ww no recovery of ‘damages for bré €ction or enforcent attorney at law, all costs including reasonable attorneys’ fees and pr cost paid by the non-prevailing Party. 20. This Agreement constitutes the entire agreement between Petitioners 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 Petitioners and the AUCA 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. 21. Petitioners 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. Petitioners 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, Petitioners 1 reserves the right 0 to re- open t this matter with the Division of Administrative Hearings : ‘ 22. This Agreement i 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. SOR per pear ae = rer as Settlement Agreement DOAH Case No. 01-2788 - Page 6 of 6 23. 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. 24, °This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 25. All times stated herein are of the essence of this Agreement. 26. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. FOR THE PETITIONERS: KE vaca: A Cptsle S2 2001 Peter A. LeWis, Esquire Goldsmith, Grout & Lewis, P.A. Attorneys for Petitioners FOR THE AGENCY FOR HEALTH CARE ADMINISTRATION: 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: f 204 R Ngle Inspector General Aa thK ELE Dated: if: x » 200, William Roberts ; | KEY WEST CONVALESCENT CTR., INC WACHOVIA BANK, N.A, PALM BEACH GARDENS, FL 33410 - VOID AFTER 90 DAYS 11000 Prosperity Farms Rd., Suite 100 Y A le Q 63-1356 / 670 Palm Beach Gardens, FL 33410 1) (561) 627-2550 nlaglor — *3u, 350, &- Dhirly Ste Dhaserrd, Dow Ubundhect SEhty Covert PAY SF Cluney ha Highenen Morac. 2. Clowolang iA L Ds Ka busy AUTHORIZED SIGNATURE wOOu Show NOGB?7O043S56urn 19: 85% 9900 te

Docket for Case No: 01-002698