STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS ALI REZA GHASEMI, Petitioner, Case No:01-3021 i (Oud ; Former Case No.:00-4332 a in CI No.: 98-0065-000 foe, “ vs. RENDITION NO.: AHCA-02-0177-S-MDO AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / 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 x 6 day of Tons , 2002, in aerbe MD, Secretary Agency for Health Care Administration Tallahassee, Florida. 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. ve to Judge . file after review ao NO COPY MADE____ pocket and Gi 1 File in case Copies Furnished to: A.S. Weekley, Jr., M.D., Esquire Holland and Knight, LLP 400 North Ashley Drive, Suite 2300 Tampa, Florida 33602-4300 Anthony Conticello Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Harry L. Hooper 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 CERTIFICATE OF SERVICE 1 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 | kh day of Gopal , 2002. Cismeid me Tre tess 4S CAgency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA hy DIVISION OF ADMINISTRATIVE HEARINGS < ‘9 , ee “Oe, “yy ALI REZA GHASEMI, Mee Po i / Petitioner, v. Case No.: 01-3021 (Former Case No.: 00-4332) AGENCY FOR HEALTH CARE C.1. No.: 98-0065-000 ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Dr. Ali Reza Ghasemi, (“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. 3. Inits Final Agency Audit Report issued on September 14, 2000 (the "Audit Letter") AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $165,704.47. In response to the Audit Letter, PROVIDER denied the overpayment and filed a petition for a formal administrative hearing that was assigned DOAH Case No.: 01-3021, Former Case No.: 00- 4332. 4. Inorder to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) (b) (c) (d) (e) () AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. AHCA agrees to accept one hundred thirty-six thousand, seven hundred seventy- six dollars and eighty-six cent ($136,776.86) as full and complete repayment of the over payment. AHCA’s office of Finance and Accounting has confirmed that the Provider has paid fifty thousand dollars ($50,000.00) toward the overpayment on September 18, 2001, which leaves the remaining amount due of eighty-six thousand, seven hundred seventy-six dollars and eighty- six cent ($86,776.86). With in thirty days of a Final Order adopting this Agreement, Provider agrees to pay to AHCA the sum of eighty-six thousand, seven hundred seventy six dollars and eighty-six cent ($ 86,776.86), 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 No. 01-3021). PROVIDER has paid AHCA fifty thousand dollars ($50,000.00) on September 18, 2001, which leave the total amount owed of eight-six thousand, seven hundred seventy-six dollars and eighty-six cent ($86,776.86). 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: DOAH Case No.: 01-3021, Former Case No.: 00-4332, C.I. No.: 98-0065-000. (g) 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. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable ‘ Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the C.I. Number. 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. The parties agree to bear their own attorney’s fees and costs, if any. 9. 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 signature alone binds PROVIDER to make the payment as set forth in this agreement. The parties further agree that a facsimile or photocopy reproduction of this agreement with PROVIDER’S signature shall be sufficient for the Agency to enforce the agreement and to cancel the hearing in this matter. However, the original executed copy must be retumed by PROVIDER to the AGENCY. 10. 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. 11. This 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 Agreement is completed and properly executed by the parties. 12, This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect undérstandings, 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. 13. This Agreement is entered into by the PROVIDER for the purpose of avoiding further administrative action with respect to this matter. No statement contained in this Agreement or made in furtherance of securing this Agreement may be used as direct evidence against the PROVIDER in any civil or administrative proceeding. 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 tules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER 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. 15. Provider, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, Tepresentatives, 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 (DOAH Case No.: 01-3021, Former Case No.: 00-4332, C.I. No.: 98-0065-000) 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 Facility. 16. 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. 17. 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. 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. SPR-25-2882 14:59 ALI REZA GHA AS, EKLEY JR., M.D. Attomey for Petitioner eee seen AGENCY FOR HESLTH CARE AD Dated: UY — ? (- j Q 2002 Dated: 29 ip 2002 ESQ, AGENCY FOR HEALTH CARE G% ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Inspector General LZ ME br Dated: LA, WILLIAM ROBERTS Acting General Counsel

Docket for Case No: 01-003021