FHLED STATE OF FLORIDA AUC 3. 02 AGENCY FOR HEALTH CARE ADMINISTRATION Lae WALGREEN’S PHARMACY #2188, Petitioner, vs. CASE NO ~04-2477 01097 STATE OF FLORIDA, AGENCY FOR “TDL HEALTH CARE ADMINISTRATION, d bP Cheaeef Respondent. / FINAL ORDER THE Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “AHCA”), issued a final agency audit report dated May 22, 2001 advising the Petitioner of an alleged overpayment of $47,510.05. In response to that audit report, the Petitioner submitted additional documentation. After the documentation was reviewed, it was determined that the Medicaid overpayment was $133.84. AHCA issued a final agency audit report dated July 9, 2002 advising the Petitioner that AHCA is not pursuing the reduced overpayment or applying sanctions. Both final agency audit reports are incorporated by reference. No other action affecting the Petitioner under the above-styled case number is pending. Based on the foregoing, the request for a hearing is dismissed and the file is CLOSED. DONE and ORDERED on this [3 day of A iy Lea , 2002, in Tallahassee, Florida. prneheeere MD, Secretary [21 Bibra 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: Garnett Chisenhall Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Bryan A. Schneider, Sr., Esquire 200 Wilmot Road Deerfield, Illinois 60015 (U.S. Mail) J.D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Kelly Bennett, Assistant Bureau Chief, Medicaid Program Integrity Kelly Rubin, Medicaid Program Integrity Willie Bivens, Finance & Accounting CERTIFICATE OF SERVICE I 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 30T by of f K vst o002, Lttrduud bl! Clon Lealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 a a ; STATE OF FLORIDA a e Lill = 4 ie a AGENCY FOR MEALTH CARE ADMINISTRATION JES BUSH, GOVERNOR May 22, 2001 on CERTIFIED MAIL ~ RETURN RECEIPT NO. 7000 1670 0009 9415 4160 Provider No. 1014081 00 License No. P?H0011952 Walgreens #02188 2750 W. 68™ St., BAT 135 Hialeah, Florida 33016 RE: FINAL AGENCY AUDIT REPORT C.I. No. 00-0485-000-3/H/KDR Dear Provider: An on-site audit of your pharmacy was initiated on January 26, 2000. The audit period was from January 6, 1999, through December 24; 1999. The Florida Medicaid Program through the Agency for Health Care Administration has determined that you have been overpaid $47,510.05 in connection with.claims submitted to Medicaid during the audit period. This conclusion is supported by the audit results. This review and the determinations were made in accordance with the provisions of Chapter 409, Florida Statutes (F.S.), and Chapter 59G, Florida Administrative Code (F.A.C.). In applying for Medicaid reimbursement, providers are required to follow the applicable statutes, rules, Medicaid provider handbooks, statements of Medicaid policy, and federal laws and regulations. Medicaid cannot properly pay for claims that do not meet Medicaid requirements. When a provider receives payment in violation of these provisions, those funds must be repaid. REVIEW DETERMINATIONS The audit included a statistical analysis of a random sampling, with the results applied to the random sample universe of claims submitted during the audit period. The actual overpayment was calculated using a procedure that has been proven valid and is deemed admissible in administrative and law courts as evidence of the overpayment. Visit AHCA Online at 2727 Mahan Drive « Mail Stop #6 www fdhe. state flius Tallahassee, FL 32308 ae, wo LAURA BRANKER, scaigetner vo, & . ~ Walgreens #02188 Page 2 Attached are the overpayment calculations, a summary of documented discrepancies, and an itemized listing of discrepancies noted in the review of the random sample. If you accept or concur with these findings, please send your check in the amount of $47,510.05, for the identified overpayment, made payable to the Florida Agency for Health Care Administration, to: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 (Note: The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the agency.) To ensure proper credit, be sure that your provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens at (850) 487-4298. You have the right to request a formal or informal hearing pursuant to section 120.569, F.S. If a petition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, F.A.C. Please note that rule section 28-106.201(2), F.A.C., specifies that the petition shall contain’ a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days of receipt of this letter. Failure to timely request a hearing shall be deemed a waiver of your right to a hearing. It is important that a request for an informal hearing or a petition for a formal hearing be sent only to the following address: . Mr. Charles G. Ginn, Chief Medicaid Program Integrity Office of the Inspector General Agency for Health Care Administration 2727 Mahan Drive, Mail Stop # 6 Tallahassee, Florida 32308-5403 Do not send requests or petitions to any other address. If a hearing request is not received within 21 days from the date of receipt of this letter, the right to such hearing is waived, and repayment of the above-~stipulated overpayment will be due and payable at the end of that 21-day period. . ~“ 6 NS Walgreens #02188 Page 3 Any questions that you may have regarding this matter should be directed to: Kelly Rubin, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive, Mail Stop # 6, Tallahassee, Florida 32308-5403, telephone number (850) 922-4374. Sincerely, D. ana Program Administrator Medicaid Program Integrity DKY/gwm Attachment(s) . ce: Medicaid Program Integrity Administrative Section Medicaid Accounts Recéivable, Attn: Willie Bivens Heritage Information Systems, Inc. Medicaid Program Development Area Medicaid Office HeritageFinLetWalgreens21 88.doc 5/11/01 STATE OF FLORIDA To Nes h, By AGENCY FOR HEALTH CARE ADMINISTRATION Og: , Oo or JEB BUSH, GOVERNOR RHONDA M. UsEEI 0, FantPfrecretany SIS ay 2. . “ghee oy, July 9, 2002 OL. CERTIFIED MAIL - RETURN RECEIPT NO. 7001 0360 0003 8770 5946 Provider No. 1014081 00 License No. PH001952 Walgreen's Pharmacy #02188 Attn: Pharmacy Manager 6800 W. 28°* avenue Hialeah, Florida 33018 RE: FINAL AGENCY AUDIT REPORT C.I. No. 00-0485-000~3/H/KDR Dear Provider: ates of service from January 1, 1999, through December 24, 1999. A final agency audit report, dated May 22, 2001, was sent to you indicating you were overpaid $47,510.05. «In response to our letter, you sent additional documentation. A review of the documentation Provided has been performed and it has been concluded that you were overpaid $133.84 by Medicaid. A copy of the amended Pharmacy Audit Final overpayment calculations, a summary of the non-compliant issues, discrepancies noted in the review of a random sample of your paid Medicaid Claims, and may contain i on-compliant issues. The Agency is not. pursuing the overpayment or applying sanctions, By copy of this letter, the Medicaid Accounts Receivable office is advised of this action. Since areas of non-compliance have been identified, we are taking this Opportunity to remind you of Medicaid policies and procedures to assist you in correcting the areas of non- compliance, and conditions specified in the provider agreement, This includes, but is not limited to, complying with federal and state laws, regulations, rules, Medicaid handbooks and policies. —_ Visit AHCA online at www fdhe. state fl.us 2727 Mahan Drive « Mail Stop #6 Tallahassee, FL 32308 Walgreen’s Pharmacy #02188 Attn: Pharmacy Manager Page 2 Section 409.913(7), Florida Statutes (F.S.), states in part that that are provided in accordance with applicable provisions of all Medicaid rules, regulations, handbooks, policies, federal, state, and local laws. Section 409.913(8), F.S., requires a Medicaid provider to retain medical, professional, financial, and business records Section 409.913(14), (15), and (16), F.S., provides that the Agency may seek any remedy provided by law, including administrative Sanctions, if the provider is not in compliance with provisions of Medicaid rules, regulations, handbooks, policies, federal, state, and local laws. Administrative sanctions may include a fine, and/or suspension or termination from the Medicaid Program. Section 409.920, F.S., addresses Medicaid provider fraud, including, but not limited to, the falsification of records and claim information in order to receive or justify receipt of payment. Chapter 465, F.S., and Rule 64B-16, Florida Administrative Code (F.A.C.), address, among other things, pharmacy practice regulations, records requirements, and the responsibility of the pharmacist to ensure the validity of prescriptions received. Other regulations include, but are not limited to: Chapter 499, F.S., the Florida Drug and Cosmetic Act, and Chapter 893, F.S., the Florida Comprehensive Drug Abuse Prevention and Control Act. It is recommended that you review the regulations that govern your practice, to include the applicable Medicaid provisions found in Chapter 409, F.S., Rule 59G, F.A.C., and the Florida Medicaid Provider Coverage, Limitations, and Reimbursement Handbook for Prescribed Drug Services. The handbook was previously sent to you by the fiscal agent. As indicated above, the Agency is not pursuing the overpayment, however, appropriate actions necessary to correct the problems noted in the audit report must be taken. Should a subsequent audit reveal similar problems or other areas of non-compliance, you will be subject to repayment of any overpayment, sanctions, and/or other actions deemed appropriate. . Walgreen’s Pharmacy #02188 Attn: Pharmacy Manager Page 3 If you have any questions concerning the above, please telephone Kelly D. Rubin, Senior Pharmacist, at 850-922-4374. Sincerely, fhe — D. Kenneth Yon AHCA Administrator Medicaid Program Integrity Attachments cc: Area Medicaid Office Willie Bivens, Medicaid Accounts Receivable Walgreens2188HeritageFromAALtoEGLexrAAL —_—e.—a ners FLORIDA MEDICAID Page: I 09/20/2001: 17:06:37 [Pharmac it ; - Series: 99. 2 Pharmacy Audit - Final Report Form RPT-3 Pharmacy: Walgreens #02188 Audit Date: 01/26/2000 dd » 2750 w b Audit Time Period: 01/06/1999 - 12/24/1999. Address: 275 . 68th St.,bat 135 Auditors: Greg Beller, RPh Hialeah, FL. 330160000 Billy Thomas, RPh Provider #: 101408100FL Maria Concepcion I. Description of Claim Samples & Overall Findings: # of Claims 5 Paid to Phey A. Total Utilization During Audit Time Period: 48,900 2,031,395.51 B. Total Judgmental Sample: wa Wa C. Discrepant Claims in Judgmental Sample: * D. Documented Overcharges in Judgmental Sample: E. Total Random Sample: 101 4,177.34 F. Discrepant Claims in Random Sample: * 3 133.84 3 133.84 G. Documented Overcharges in Random Sample: H. Random Sample Average Overcharge Amount("G" divided by "E"): 1.32514 I. Random Sample Universe ("A" minus "B")- . J. Extrapolated Overcharges ("H" multiplied by "I": 64,799.76 K. Total Calculated Overpayment ("D” plus "J": L. 95% One-Sided Lower Confidence Limit of Extrapolated Random Sample 133.84 M. Documented Overcharges in Judgemental Sample (Line "D") 0.00 133.84 N. Total Recommended Recoveries: (Includes 95% One-Sided Lower Confidence Limit of Extrapolated Random Sample Plus Judgmenta! Findings, if any, from line "M") II. Summary of Actual Discrepancies Documented (see Section IV for claim-level detail) Code Discrepancy Description CF Original hard-copy Prescription cannot be found on file during the audit. * Some discrepancies may not call for Monetary recoveries. These are noted (o the pharmacy for educational Purposes only, Since some claims have multiple discrepancies, individual claims may be listed twice, therefore may exceed the number of discrepent claims listed in section 1. # Discrepancies FLORIDA MEDICAID Page: 2 09/20/2001: 17:06:39 a Series: 99.9 Pharmacy Audit - Final Report Form RPT.3 Pharmacy: Walgreens #02188 Provider #: 101408100FL TT II. Comments / Notes: . Post-audit documentation was received and reviewed. Based on the review, changes were made and the overcharges were reduced, Member ID 17288180200 74980237900 26593359800 FLORIDA MEDICAID Walgreens #02188 Ret 1050102 902755 909300 Dos orr Drug NDC 07/18/1999 60 PENTOXIFYLLITAB 400MG ER 00228261111 04/02/1999 30 PREVACID CAP SMG DR 00300154130 04/18/1999 30 BUMETANIDE TAB IMG 00378037001 Total Paid Amount Page: 3 09/20/2001: 17:06:40 Pharmacy Audit - Final Report Fomnprs Pharmacy: Provider #: 101408] OOFL IVb. Discrepancy Listing - Random Sample: Paid Discrepancies Amount 22.18 CF 102.26 CF 9.40 CF 133.84 Total Overcharges Overchar

Docket for Case No: 01-002771