STATE OF FLORIDA rena 09 DIVISION OF ADMINISTRATIVE HEARINGS eee Ns me LE Ses poy LAKE WALES MEDICAL CENTER, Petitioner, CASE NO: 01-4512 v. PROVIDER NO.: 01016640 CI. NO.: 00-1684-000 AGENCY FOR HEALTH CARE RENDITION NO.: AHCA-02-113 -S-MDP ADMINISTRATION, Respondent. / oO Lae) = FINAL ORDER . were oO 4 THE PARTIES resolved all disputed issues and executed a settlement agreemat Cv4 Or EF ee which is attached and incorporated by reference. The parties are directed to cofaply with 84 the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE AND ORDERED on this the / [ day of / tfltr , 2002, in Tallahassee, Florida. jo bitten: MD, Secretary ft seems 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: W. David Watkins, Esquire Watkins & Caleen, P.A. 1725 Mahan Drive, Suite 201 Post Office Box 15828 Tallahassee, Florida 32317-5828 (U.S. Mail) Anthony Conticello Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice) William R. Cave Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Interoffice) Charlie Ginn, Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 (Intero ffice) Finance & Accounting (Interoffice) 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 29 day of Ly yi 0: , 2002. VitcninBaire Esquire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 PULED STATE OF FLORIDA DIVISI TRATIVE HEARIN SION OF ADMINISTRA H GS 02 APR 30 AM 5 49 LAKE WALES MEDICAL CENTER, Petitioner, : CASE NO: 01-4512 v. C.1. NO.: 00-1684-000 AGENCY FOR HEALTH CARE JUDGE: W. R. CAVE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Lake Wales Medical Center (“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. On September 5, 2001, AHCA issued Petitioner a Final Agency Audit Report, CI NO.: 00-1684-000, (the "Audit Letter"). In the Audit Letter, AHCA notified PROVIDER that a review of PROVIDER’s specified Medicaid claims, during the time period of August 14, 1995, to March 10, 1996, was performed by Medicaid Program Integrity (MPI). For reasons specified in the Audit Letter, AHCA determined that some of the audited claims were not proper and therefore considered “overpayments”. The Audit Letter identified a total overpayment in the amount of $2,480.12. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing that was assigned DOAH Case No. 01-4512. Based upon the factual circumstances present in this case and the age of the claims, the overpayment has been amended, and now totals $620.03 (the “Amended Overpayment”). PROVIDER has agreed to pay the Amended Overpayment in total, and an additional $379.97, in investigational costs. Both of these sums total $1,000.00. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: a) (b) (d) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues set forth in the Audit Letter. Within sixty (60) days of PROVIDER’s execution of this Agreement, PROVIDER agrees to pay to AHCA the sum of $1,000.00 as set forth in paragraph no. 1, 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. 01-4512). PROVIDERS shall be 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. 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 Letter, referenced as CI NO.: 00-1684-000. (e) 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. 4. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 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, PROVIDERS agrees that its signature alone binds PROVIDERS to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Settlement Agreement to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel the final hearing and have the Division of Administrative Hearings relinquish jurisdiction back 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 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. 13. 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 rules 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. However, if for any reason this Agreement is not subsequently adopted by a Final Order, PROVIDER is no longer bound by its terms, the parties will confer to continue negotiations, and if unsuccessful the matter shall be referred to DOAH for an administrative hearing and the monies paid to AHCA by PROVIDER shall be immediately refunded. 14. Provider, 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 DOAH Case No. 01-4512, CI NO.: 00-1684-000, 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. 15. 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. 16. To the extent that any provision(s) of this Agreement is prohibited by law, for any reason, such provision(s) shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. LAKE WALES MEDICAL CENTER ooo (ae Ttpshevues S-S-ORK,, 2002. Lance Anastasio (Print name above) PRESIDE Dated: 7//2- , 2002. W. DAVID WATKINS, ESQUIRE ATTORNEY FOR PETITIONER AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 ad het Inspector General WILLIAM ROBERTS Acting General Counsel ity ANTHONY. CONTICELLO, ESQ. Assistant General Counsel Dated: a M , 2002. Dated: S\ \ , 2002. Dated: , 2002.

Docket for Case No: 01-004512MPI