STATE OF FLORIDA AMERICAN CONSULTANTS, INC., Petitioner, vs. AGENCY FOR HEALTH CARE ADMINISTRATION, : Respondent. and DOS OF NORTH SHORE LIMITED, Petitioner, . VS. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. DOAH CASE NO. 01-2703 Audit No. 00-1497-003 Rendition No. AHCA- 02-0011-S- MDO MMP eLesedf DOAH CASE NO. 01-2785 Audit No. 00-1497-018 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. Frere DONE AND ORDERED on this the fA day of lagna ed , 2002¢in Tallahassee, Florida. Rhonda cafe MD, Secretary Agency for Health Care Administration oer ee ea aed 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: Peter A. Lewis, Esquire Goldsmith, Grout & Lewis, P.A. 307 West Park Avenue Tallahassee, Florida 32301-1017 Kelly A. Bennett, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Michael E. Parrish Administrative Law Judge 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 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 Finance & Accounting hale obit, sii ot ib 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 a3 day of ( pe Caney , 2002, { Ch VWeelere Whe k = ZA gency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5865 me meer ror oe one RE ee ee eed ee ee es oe Pe nape ak i ois deh. pe # Loa STATE OF FLO DIVISION OF ADMINISTRATI Ne 02 AMERICAN CONSULTANTS, INC., Petitioner, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. and DOS of NORTH SHORE LIMITED, DOAH CASE NO: 01-2703 JUDGE: Michael M. Parrish provider no.: 021198200 audit no.: C.I. 00-1497-003 Petitioner, DOAH CASE NO: 01-2785 v. JUDGE: Michael M. Parrish provider no.: 021403500 audit no.: C.I. 00-1497-018 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 DOS of North Shore Limited (“Petitioner”): 1. This matter arises out of AHCA’s review of ‘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 oer repre rere iia. a ih alii ia vob ss hibiniaats bs a il li Action Letters (FAAL) that determined American Consultants and DOS of North Shore had been overpaid by Medicaid in the amount of $209,220.12 (DOS of North Shore) and $18,032.76 (American Consultants) for receiving H Supplements for several Medicaid Recipients for whom the facility had not received Prior Authorization nor had the recipient been deemed eligible for an institutional care program (ICP eligible). 2. Petitioner filed petitions challenging AHCA’s determination and requesting formal administrative hearings. Petitioner agreed to resolve both matters because Petitioner is the successor in interest of American Consultants, (Hereinafter, Petitioner for itself and in its representative or successor capacity for American Consultants shall be referred to as PROVIDER). 3. The parties agree that the ICP 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 Ic eligibility for the subject recipients or any other recipients of PROVIDERS’ facilities. However the parties agree that should AHCA seek such repayment, PROVIDER does not waive any defenses it may have. 4. As a part of trial preparation, the parties have engaged in extensive document review and discussions, and agree as follows: a. Subsequent to issuance of the FAAL, documentation that AHCA has reviewed. b. The subsequent documentation results in an adjusted overpayment amount totaling $223,973.92. c. Prior authorization is required prior to billing Medicaid for the H Supplement. S ccaaiiaekaeil ed d. PROVIDER’S actions in failing to obtain prior authorization did not comport to the clear and unambiguous Medicaid billing requirements. e. PROVIDER agrees to repay the adjusted overpayment amount, plus interest, over a thirty-month period. oswnt BEd ds Bae: In order to resolve this matter without further administrative proceedings and or actions, PROVIDER and AHCA expressly agree as follows: (C) (D) ©) ®) AHCA agrees to accept the payment set forth herein in settlement of the issues arising from Audit Nos. CI 00-1497-003 and CI 00-1497-018. PROVIDER agrees to make thirty (30) monthly payments of eight thousand four hundred sixty-eight dollars and seventy-seven cents each ($8,468.77) by the fifth day of each consecutive month, beginning on or before January 5, 2001, as full and compiete settlement of the overpayment issue before the Division of Administrative Hearings (DOAH Case Nos. 01-2703 and 01-2785). PROVIDER also agrees that, pursuant to Florida Statutes, statutory interest accrues on the amount due and owing to AHCA, such that each of the aforementioned payments includes an interest payment in accordance with -the attached amortization schedule. In the event that PROVIDER pays the total amount due prior to the scheduled payments, the interest amounts will be recalculated to ensure that PROVIDER does not pay excess interest. POR mem Soe peepee Pore cere or ana ee He (G) PROVIDER agrees that the each of the monthly payments are due on the (H) fifth (5) day of each month, beginning on January 5, 2002, until all payments are made. Payments are due at AHCA by the fifth of the month. PROVIDER is responsible for ensuring timely delivery of payments. Furthermore, failure to timely make any payment will render the remaining outstanding amount 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. PROVIDER also agrees to participate in education courses regarding Medicaid policies and procedures for nursing facilities. PROVIDER, via the Chief Financial Officer, the Nursing Facility Administrator, and the primary billing employee shall, within six months of signing this agreement, attend and successfully complete a course primarily designed to teach Medicaid policies and procedures for nursing facilities. PROVIDER agrees to provide written documentation of the successful completion of the training to Kelly A. Bennett, whose address is: 2727 Mahan Drive, Office of the General Counsel, Mail Stop #3, Tallahassee, Florida 32303. PROVIDER may consult with AHCA’s Area 10 or 11, Medicaid Office (Ft. Lauderdale or Miami) for recommendations regarding the required course. Serr ne ere oe onperee ce oar sage 63) ey) «) @) PROVIDER will, within 30 days of signing this agreement, submit documentation regarding measures to ensure future compliance with Medicaid statutes, rules, regulations, or policies, and statutes, rules, regulations, or policies, that govern the pharmacy practice. Such compliance documentation should be submitted to Kelly A. Bennett, whose address is listed above at paragraph “H”. PROVIDER and AHCA agree that full payment as set forth above, successful completion of the training, and documentation of a compliance program, will resolve and settle these cases completely and release both parties from all liabilities arising from the audits referenced as: CI 00-1497- 003 and CI 00-1497-018. | PROVIDER agtees 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. PROVIDER agrees that failure to make payment, attend training, document compliance, or submit the required documentation per the terms of this agreement may result in the Agency pursuing all legal means to enforce this agreement, may include a request for attorney fees and all costs associated with the enforcement of this agreement, and may include adverse action toward PROVIDER’S ability to participate in the Medicaid Program. Se prre gmern reo appre satis Bi ih dbl ilies a dk 6. The monetary payment shall be made payable to: AGENCY FOR HEALTHCARE ADMINISTRATION 7. Each payment/check shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Numbers, and shall reference the C.I. Numbers. 8. Payments shall be delivered to AHCA, Medicaid Accounts Receivable, ATTN: Willie Bivens, Agency for Health Care Administration, 2727 Mahan Drive, Building 1, Tallahassee, Florida 32308-5403, or Post Office Box 13749, Tallahassee, Florida 323 17-3749. 9. 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. 10. | 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. 11. Each party shall bear its own attorneys’ fees and costs, if any. 12. 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, PROVIDER agrees that its representative signature alone binds it to make payment, attend training, document compliance, and submit the required documentation per the terms of this agreement, while this agreement is in n process for signatures with AHCA. | pie Bae 13. The parties further agree that a facsimile or photocopy reproduction of of this agreement with PROVIDER’S signature alone shall be sufficient for the Agency to. enforce the agreement. ee ee COO O SeT a OT cere AHCA will supply PROVIDER with a copy of the fully executed agreement as soon as it is available. 14. 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. 15. Inthe event that PROVIDER 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 attorney at law, all costs of collection or enforcement, including reasonable attorneys’ fees and costs, shall be paid by PROVIDER to AHCA. _16. 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 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. 17. 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. 18. | PROVIDER expressly waives in this case its right to any hearing pursuant to Sections 120.569 or 120.57, Florida Statutes, the Agency making any findings of fact and conclusions of law, and all further and other proceedings to which it may be entitled by law or rules of the Seeger eng ee ad canta 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 regarding the subject audit 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. 19. PROVIDER, for themself 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 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 PROVIDER. 20. 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. 21. 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 22. Upon complete execution of this Agreement by PROVIDER this Agreement constitutes PROVIDER’S dismissal of the petitions and authorizes AHCA to file a Motion to Relinquish Jurisdiction with the Division of Administrative Hearings. 23. 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. epee Dec. 4. 2001 19:42AM No-0782 PP. 10 PETITIONERS DOS OF NORTH SHORE . _———— ( Dude VA- AS Dated: 24 § 2001 Petitioner/Provider AMERICAN CONSULTANTS ( J - Y c Dated: Ry ia , 2001 Petitioner/Provider Dated: “-2/G 2001 - Peter Lewis, Esquire Attomey for Petitioner AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 VA fe wo te Dated: (aa , 200R— Rufus N¢ble Inspector General ~~ L - ~ Dated: , 2002 William Roberts Assistant General Counsel 2 ore gem aera eR me eee pe eres ee . STATE OF FLORIDA “ DIVISION OF ADMINISTRATIVE HEARINGS AMERICAN CONSULTANTS, INC., -Petitioner, Case No. 01-2703 vs. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ORDER CLOSING FILE This cause having come before the undersigned on the parties' Motion to Cancel Hearing and Relinquish Jurisdiction filed November 30, 2001, and the undersigned being fully advised, it is, therefore, - : ORDERED that: 1. The final hearing in this cause scheduled for December 11, 2001, is hereby cancelled. - 2. The file of the Division of Administrative Hearings in the above~captioned matter is hereby closed, and jurisdiction is relinquished to the agency. DONE AND ORDERED this 3rd day of December, 2001, in Tallahassee, Leon County, Florida. at MICHAEL M. PARRISH Administrative Law Judge Division of Administrative Hearings The DeSoto Building | 1230 Apalachee Parkway DEC =.5 2001 Tallahassee, Florida 32399-3060 Sense hee eet (850) 488-9675. SUNCOM 278-9675 cee a EALTH CARE Fax Filing (850) 921-6847 MINISTRATION-LEGa® www.doah.state.fl.us r SUR a rere rr ve thas side th, du ai wiki STATE OF FLORIDA “ DIVISION OF ADMINISTRATIVE aes ans i nla DOS OF NORTH SHORE, LTD., _ Petitioner, Case No. 01-2785 vs. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ORDER CLOSING FILE This cause having come before the undersigned on the parties' Motion to Cancel Hearing and Relinquish Jurisdiction filed November 30, 2001, and the undersigned being fully advised, it is, therefore, ORDERED that: 1. The final hearing in this cause scheduled for December 12, 2001, is hereby cancelled. 2. The file of the Division of Administrative Hearings in the above-captioned matter is hereby closed, and jurisdiction is relinquished to the agency - DONE AND ORDERED ‘this 3rd day < of December, 2001, in Tallahassee, Leon County, Florida. . D ’ NEXI Vi | ‘MICHAEL M. PARRISH W [ Administrative Law Judge Division of Administrative Hearings a The DeSoto Building OEC - 5 200 : 1230 Apalachee Parkway a . “ Tallahassee; Florida 32399-3060 EO ee eee CARE (850) 488-9675. _ SUNCOM 278-9675 .. ; “— ~ Fax Filing (B50), 921- 6847 : www. doah.state. fl.us oe rer perenne cere POORER Creer Semmes ee or oye per ee ores ee oe

Docket for Case No: 01-002785