AUS 16 02 STATE OF FLORIDA 7 AGENCY FOR HEALTH CARE ADMINISTRATION. PART MF # CER =. eo ei a x # MERCY HOSPITAL, INC., ie o a Of Petitioner, DOAH CASE NO: 02-0594MPf PROVIDER NO: 010043900 v. C.1. NO: 01-1161-000 f STATE OF FLORIDA, SMmL ¢ leac 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 attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the | ) ty of Brsushioe, in Tallahassee, Florida. “Row Rhonda M. Medowg, MD, Secrajary Agency for Health Care Administration A PARTY WHOIS 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: SUSAN C. FELKER-LITTLE, Esquire Assistant General Counsel Agency for Health Care Administration (“AHCA”) (Interoffice Mail Stop #3) LEWIS W. FISHMAN, Esquire Two Datran Center — Suite 1121 9130 South Dadeland Boulevard Miami, Florida 33156 S. M. LERNER, Administrative Law Judge The Division of Administrative Hearings The DeSoto Building ‘ 1230 Apalachee Parkway Tallahassee, Florida 32399-30060 Charlie Ginn, Chief, Medicaid Program Integrity Kathleen Cook, Medicaid Program Integrity Willie Bivens, Finance and Accounting 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 2 Thay of Prugyst , 2002. Leakud dn’ Choe Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 Puy pe LED 02 dug , MERCY HOSPITAL, INC. DOAH Case No,2- ams 29 Provider No. 010043900 CLL No. 01-1469 ee Ciat SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and MERCY HOSPITAL, INC. (“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, and neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its final agency audit report dated November 15, 2001, AHCA notified PROVIDER that the Medicaid Program Integrity office had received information based on a retrospective medical record review by the Keystone Peer Review Organization (KePRO) respecting Medicaid claims billed where either the inpatient admission or a portion of the length of stay was not medically necessary for Medicaid recipients. The Agency sought overpayment in the amount of $86,953.02 by way of an audit letter dated November 15, 2001. PROVIDER then filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 02- 0594MPI. 4. In order to resolve this matter without further administrative or legal proceedings, PROVIDER and the AHCA expressly agree as follows: 1 Mercy SA 5-2-02 (a) (b) (c) (d) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the KePRO review. Within thirty days of receipt of the final order, PROVIDER agrees to make a one-time payment to repay THREE THOUSAND, FIVE HUNDRED, SIXTY-EIGHT DOLLARS AND THIRTY-FIVE CENTS ($3,568.35) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings, Case No. 02- 0594MPI. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 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 C.1. 01-1161- 000. PROVIDER agrees that it will not bill or 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. 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 2 Mercy SA 5-2-02 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. 6. AHCA reserves the right to enforce this Agreement if breached under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 7. 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. 8. Each party shall bear its own attorneys’ 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. 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. 1. 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. Mercy SA §-2-02 W 13. 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. 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 rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that it shal! not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal, 13. 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 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. Mercy SA 5-2-02 4a 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. MERCY HOSPITAL, INC. PIA S z= Dated: Ape | dad , 2002 BY: V1 anue\ P Fluton gti (Print name) ITS:Sentee Via Desde d Medica | Direc be, . STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 toe Dated: , 2002 Bob Sharpe Deputy “Secretary, Medicaid ze Ae LIE. bp — Dated: PL , 2002 William H. Roberts Acting General Counsel Dated: Dt He te , 2002 C. Felker-Little Assistant General Counsel 5 Mercy SA 5-2-02

Docket for Case No: 02-000594MPI