STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION 7 f2 02 NATIVITY MEDICAL CENTER, Petitioner, Qi: Cleaecd vs. DOAH CASE NOS. 01-4527 Provider No. 060047400 Audit No. C. I. 98-0191-000 AGENCY FOR HEALTH CARE RENDITION NO.: AHCA-02-0075 -S-MDO ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed” wey _ 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 & day of Marte , 2002, in Tallahassee, Florida. ; lie f Rhonda M. Medows, M.D., 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: Lester Perling, Esquire Broad and Cassel 500 East Broward Blvd. 1130 Broward Financial Centre Ft. Lauderdale, FL 33394 Kelly Bennett, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Stuart M. Lerner Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and 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 the / 9 day of Batek , 2002. Agency’ Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 2-28-2082 9:09 AGENCY FOR HEALTH CARE AD’ 852 413 9313 P.g2 STATE OF FLORIDA v2 MAR 20 Ay Shy DIVISION OF ADMINISTRATIVE HEARINGS NATIVITY MEDICAL CENTER, 1S Petitioner, Vv. DOAH Case No. 01-4527 5 JUDGE Stuart M. Lerner Audit No. CI 98-0191-000 Provider No. 0600474-00 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / See SETTLEMENT AGREEMENT Sl SNE AGREEMENT This settlement agreement (“Agreement”) is entered into by and between the Agency for Health Care Administration (“AHCA”), and NATIVITY MEDICAL CENTER, (“Petitioner”): 1. This matter arises out of AHCA’s review of Petitioner’s paid claims to Medicaid for the period of time March 1, 1996 through March 25, 1998. On September 27, 2001, AHCA issued a Final Agency Action Letter (FAAL) that determin$d Petitioner had been overpaid by Medicaid in the amount of $48,066.37, 2. Petitioner filed-a petition challenging AHCA’s deteination and Tequesting a formal administrative hearing. 3. However, subsequent to he filing of a petition, Petitioner agreed to pay the Overpayment amount of $48,066.37, and to withdraw the request for administrative hearing. 4. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be settled because the Parties have agreed to the terms contained within this agreement. JAN-28-2082 9:99 AGENCY FOR HEALTH CARE AD 838 413 9313 P.@3 Settlement Agreement DOAH Case No. 01-4527 Page 2 of 5 3. AHCA agrees to accept the full overpayment amount ($48,066.37), in the manner set forth herein in settlement of the Overpayment issues arising from the MPI Teview, 6. Petitioner agrees to pay to AHCA the sum of forty-eight thousand sixty-six dollars and thirty-seven cents ($48,066.37), to be paid in twenty-four installments. The first twenty-three installments are in the amount of $2,218.02 and the final payment is in the amount of $2,218.00. Each payment is to be made on or before the first of every month beginning on March 1, 2002. 7. Petitioner is 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. 8. Petitioner 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: Cl. 98-0191-000 9. Petitioner 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, 10. Payment shall be made payable 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, shal] reference the DOAH Case Number, and shall reference the C.J, Number. Il. Upon complete execution of this Agreement by Petitioner this Agreement constitutes Petitioner’s’ dismissal of the petition and authorizes AHCA to file a Motion to Relinquish Jurisdiction with the Division of Administrative Hearings. JAN-28-2882 99:99 AGENCY FOR HEALTH CARE AD 858 413 9313 P.@4 Settlement Agreement DOAH Case No. 01-4527 Page 3 of 5 12. The parties will bear their own fees and costs associated with these proceedings. 13. 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, Petitioner agrees that his signature alone binds him to make the payment as set forth in this agreement: The parties further agree that a facsimile or photocopy reproduction of this agreement with Petitioner's signature alone shall be sufficient for the Agency to enforce the agreement and to cancel the hearing in this matter. 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. In the event Petitioner breaches this Agreement, and enforcement of this Agreement or Tecovery of damages for breach hereof is obtained by law or by legal proceedings through an attomey at law, all costs of collection or enforcement, including reasonable attomeys’ fees and costs, shall be paid by Petitioner to AHCA. 16. This Agreement constitutes the entire agreement between Petitioner and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agrecments or understandings; there are no Promises, Tepresentations or agreements between Petitioner 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. Petitioner 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. Petitioner further agrees JAN-28-2002 @9:@9 AGENCY FOR HEALTH CARE AD 858 413 9313 P.@S Settlement Agreement DOAH Case No. 01-4527 Page 4 of 5 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 AHCA does not adopt this agreement, Petitioner Teserves the right to re-open this matter with the Division of Administrative Hearings. 18. 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. 19. 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. ynIeo7ewwe = WyiwY AGENCY FOR HEALTH CARE AD’ 854 413 9313 pgs Settlement Agreement DOAH Case No. 01-4527 Page 5 of § NATIVITY MEDICAL CENTER G ‘tho 7. Onto Dated: 2- AS , 2002 Adenunis trator Pir Petitioner/Provider WA Dated: 2/14 , 2002 ~Perling: ire dernarl Cassed, Attomey for Petitioner AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Me Dated: 3/7 ; 2008— RufudNoble Inspector General eke. Mk Pmt Dated: BLT, 2002. William Roberts Acting General Counsel \ sistarit General Counsel 2,218.00 Page 1 of 1 TATA RA An

Docket for Case No: 01-004527MPI

Issue Date	Proceedings
Mar. 20, 2002	Final Order filed.
Feb. 26, 2002	Order Closing File issued. CASE CLOSED.
Feb. 21, 2002	Motion to Cancel Hearing and Relinquish Jurisdiction (filed by Respondent via facsimile).
Feb. 11, 2002	Order issued (Respondent`s Motion to Allow Testimony by Deposition in Lieu of Trial Testimony is granted).
Feb. 07, 2002	Notice of Taking Deposition Duces Tecum (filed by Respondent via facsimile).
Feb. 01, 2002	Motion to Allow Testimony by Deposition in Lieu of Trial Testimony (filed by Respondent via facsimile).
Jan. 14, 2002	Amended Notice of Video Teleconference issued. (hearing scheduled for April 9 and 10, 2002; 9:00 a.m.; Fort Lauderdale and Tallahassee, FL, amended as to Location and type of hearing).
Dec. 11, 2001	Respondent`s First Request for Production of Documents (filed via facsimile).
Dec. 11, 2001	Respondent`s First Request for Admissions (filed via facsimile).
Dec. 11, 2001	Notice of Service of Interrogatories (filed by Respondent via facsimile).
Dec. 03, 2001	Notice of Hearing issued (hearing set for April 9 and 10, 2002, 9:00 a.m.).
Dec. 03, 2001	Order of Pre-hearing Instructions issued.
Nov. 29, 2001	Joint Response to Initial Order (filed via facsimile).
Nov. 27, 2001	Initial Order issued.
Nov. 21, 2001	Final Agency Audit Report filed.
Nov. 21, 2001	Petition for Formal Administrative Hearing filed.
Nov. 21, 2001	Notice (of Agency referral) filed.