STATE OF FLORIDA “a9 89 AGENCY FOR HEATH CARE ADMINISTRATION ve SANTAFE HEALTHCARE, INC., d/b/a LAKE SHORE HOSPITAL, Petitioner, vs. DOAH CASE NOS. 02-0592 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / 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 / F day of Mey , 2002, in Tallahassee, Florida. Rhonda ff. 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: R. Terry Rigsby 215 South Monroe Street Suite 440 Tallahassee, FL 32301 Kelly Bennett, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Kathy Brown Medicaid Program Integrity 2002 Old St.Augustine Rd. Bldg. D MS# 6 Tallahassee, FL Bob Maryanski Medicaid Program Development 2727 Mahan Drive Fort Knox Building 3, Mail Stop 20 Tallahassee, Florida 32308 Charlie’ Ginn Medicaid Program Integrity 2002 Old St.Augustine Rd. Bldg. D MS# 5 Tallahassee, FL Willie Bivens, Finance and Accounting CERTIFICATE OF SERVICE te oe ae te Coad furnished to the above-named people by U.S. Mail this 22nd day of Ms, 2002. "Dis eceTHWSS 4p€ Vir ginia Daire, Agency Clerk State of Florida, Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Know Building III Tallahassee, Florida 32308-5403 Santa Fe Healthcare, Inc. DOAH Case No.: 02-0592 > < STATE OF FLORIDA CBE, DIVISION OF ADMINISTRATIVE HEARINGS rs SANTAFE HEALTHCARE, Inc., d/b/a LAKE SHORE HOSPITAL, Petitioner, DOAH CASE NO: 02-0592MPI ve JUDGE: Barbara J. Staros 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 SANTAFE HEALTHCARE , INC. d/b/a LAKE SHORE HOSPITAL, (“Petitioner”). 1. This matter arises out of AHCA’s review of Petitioner’s paid claims to Medicaid for the period of time between July 1, 1994 and December 31,1996. On January 25, 2001, AHCA issued a Final Agency Action Letter (FAAL) that determined Petitioner had been overpaid by Medicaid in the amount of $20,043.03. 2. Petitioner filed a petition challenging AHCA’s determination and requesting a formal administrative, hearing with respect to only one of the eleven claims. 3. Petitioner provided additional arguments regarding the one disputed claim which consisted of $5,911.92 in alleged overpayment. Santa Fe Healthcare, Inc. DOAH Case No.: 02-0592 4. Upon further discovery, and review by the parties and their medical experts, it is agreed that a portion of the disputed claim is not an overpayment. The parties agree that the overpayment is $17,021.07. 5. In order to resolve this matter without further administrative proceedings, Petitioner has agreed to pay $17,021.07, and to withdraw its request for administrative hearing. 6. AHCA agrees to accept $17,021.07, in the manner set forth herein in settlement of the overpayment issues arising from the Medicaid review (C.I. 00-1682-000). 7. Petitioner has already paid to AHCA the sum of fourteen thousand one hundred twenty- nine dollars and eighty three cents ($14,129.83). 8. Petitioner agrees to pay to AHCA, in one lump sum, two thousand eight hundred ninety- one dollars and twenty-four cents ($2,891.24), to be paid to AHCA within thirty (30) days of the issuance of a final order adopting this agreement. 9. Petitioner is responsible for ensuring timely delivery of the payment. F urthermore, 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. 10. _ 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: C.I. 00-1682-000. 11. Petitioner agrees that it will not re-bill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 12. Payment shall be made payable to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 DOAH Case No. 030502 Payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the C.I. Number. 13. | 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. 14. The parties will bear their own fees and costs associated with these proceedings. 15. 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. 16. | 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. 17. This Agreement constitutes the entire agreement between Petitioner and AHCA, including anyone acting for, associated with or employed by them, concerning all matters relating to audit no, CI 00-1682-000 and supersedes any prior discussions, agreements or understandings; there are no promises, representations 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. 18. 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 that the Agency shall issue a Final Order adopting the terms of this settlement. However, if for any reason AHCA does not adopt this agreement, Petitioner reserves the right to re-open this matter with the Division of Administrative Hearings and shall have not waived any rights. R TERRY RIGSBY, PA 4715/02 O8:4zZ4am F. OOS Santa Fe Healtheare, Inc. 4 DOAH Case No.: 02-0592 ¥, “ ¢ 19. This Agreement is and shall be deemed jointly drafted and written by ‘par s to’ ign shall not be construed or interpreted against the party originating or preparing it. Oy 20. 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. 21. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. SANTAFE HEALTHCARE, INC. Petitioner/Provider 560 East Franklin Street Lake City, FL 32055 Dated: Y— (5 2002 By: Step en J deMotyoltu (please print name above) ts: 0: VP aud Geucre L Gvxnse/ (please print title above) Dated: , 2002 R. Terry Rigsby Counsel for the Petitioner . 215 South Monroe Street Suite 440 Tallahassee, FL 32301 M remainder of page intentionally left blank Santa Ie Healthcare, Inc. . DOAH Case No.: 02-0592 %, ae 19. This Agreement is and shall be deemed jointly drafted and written By ail série & Ond shall not be construed or interpreted against the party originating or pre daha, ws 4 “te 4, 20. To the extent that any provision of this Agreement is prohibited by om rosson, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. 21. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. SANTAFE HEALTHCARE, INC. Petitioner/Provider 560 East Franklin Street Lake City, FL 32055 Dated: , 2002 By: (please print name above) Its: (please print title above) Dated: Ap uf LS” 2002 Counsel for the Petitioner 215 South Monroe Street Suite 440 Tallahassee, FL 32301 @ remainder of page intentionally left blank Santa Fe Healthcare, Inc. DOAH Case No.: 02-0592 AGENCY FOR HEALTH CARE con “ ADMINISTRATION Bea ~ on 2727 Mahan Drive, Mail Stop #3 A a Cs Tallahassee, FL 32308-5403 “ a Labels, Dated: ( S ; Rufus N@le Inspector General LK She — Dated: S/O 2002 “ William Roberts Acting Gener4l Counsel? a , a $ A y Z Dated: YYArZs Wha , 2002 elly Bernett “ Assistant General Counsel ™@ remainder of page intentionally left blank LAW OFFICES OF R. TERRY RIGSBY, P.A. 215 SOUTH MONROE STREET, SUITE 440 TALLAHASSEE, FLORIDA 32301 April 16, 2002 Kelly Bennett, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Building 3 Tallahassee, FL 32308 Re: Santa Fe Health Care v. AHCA DOAH Case No. 02-0592MPI Dear Kelly: ind SENGAAL COUNSEL APR 17 2092 Agency for Health Care Administration Enclosed please find the settlement agreement in the above-referenced matter with original signatures. Thank you for your cooperation. Sincerely, —_—_—_—_oOo a? R. reny Rigsby \ Enclosure Telephone: (850) 224-8676 * Facsimile: (850) 681-9792

Docket for Case No: 02-000592MPI