STATE OF FLORIDA eT 16 02 AGENCY FOR HEATH CARE ADMINISTRATION © ' - _ ray LOWER KEYS MEDICAL CENTER, Petitioner, TDP cleaed : CASE NO. 01-4505 CI 01-1061-000 ‘”: Provider No. 010119200 AHCA-02- -S-MBB 12 10 20 q { i vs. } ie) AGENCY FOR HEALTH CARE ADMINISTRATION, RENDITION NO.: Respondent. / eo FINAL ORDER THE PARTIES resolved all disputed issues and executed a “settlement agreement”, which is incorporated by reference. The parties are directed to comply with the terms of the “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the _!(P_ day of Cctolxee , 2002, in Tallahassee, Florida. Rhonda M. Medows, MM., Secretary 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: Martin D. Prins P.O. Box 3079 Independence, MO 64055 Kim A. Kellum, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 J.D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and Accounting Mike Morton, Medicaid Program Integrity - 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. il or hee. Interoffice Mail on this the {do day of ‘OeEa , 2002. Chaglene Tax oom AEX Lealand ao Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA 0. ° DIVISION OF ADMINISTRATION HEARIN' ST >, : ‘ Ph; AK o. 16 A aahell OM, Lint oe Saal LOWER KEYS MEDICAL CENTER, Petitioner, vs. Case No. 01-4505 Provider No. 010119200 CI No. 01-1061-000 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, Lower Keys Medical Center, by and through the undersigned individuals, hereby stipulate and agree as follows: 1. This settlement agreement is entered into between the parties in order to resolve a dispute that arose as the result of a KePRO review. 2. Ina final agency audit letter dated September 12, 2001, Petitioner was informed that the Agency sought recoupment in the amount of $42,144.90. A copy of the recoupment letter is attached to this agreement. 3. Petitioner challenged Respondent's action and requested a formal hearing regarding the claims in question. 4. Subsequently, the Respondent reviewed additional documentation. . 5. To avoid the further time and expense of litigation, and for their mutual benefit, the parties are desirous of settling all the disputed matters. 6. The Agency agrees to allow the Petitioner, Lower Keys Medical Center, to pay the Agency the total sum of $22,100.00 within sixty (60) days of execution of the Settlement Agreement. 7. j%In the event the Petitioner fails to make any payment due hereunder, the Respondent may, at its option and upon fifteen days written notice to Petitioner, declare Petitioner in default. Its provider number shall be suspended until such time as the Agency receives payment of the balance in full. 8. Payments shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 9. This settlement does not constitute an admission of wrongdoing or error by either party. However, the parties believe that this matter should be settled. 11. Both parties request that the Agency close the file in this case. 12. Each party shall bear its own attorney's fees and costs. 13. This agreement represents the entire agreement between-the parties regarding settlement of this case. 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. The signatories to this agreement, acting in a representative capacity, represent that they are duly authorized to act on behalf of the parties to the agreement. Venue for any action arising from this agreement shall be in Leon County, Florida. Dated this day of of 2002. ~ ‘AGENCY FOR HEALTH CARE ADMINISTRATION William H. Roberts Acting General Counsel Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Building 3 Talla see, Flori 08 ~..Bob Sharpe, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Building 3 Tallahassee, Florida 32308 LOWER KEYS ME AL CENTER Martin D. Prins, Esquire P.O. Box 3079 Independence, MO 64055 Cc: Mike Morton, Medicaid Program Integrity

Docket for Case No: 01-004505MPI