STATE OF FLORIDA Pet oe DIVISION OF ADMINISTRATIVE HEARINGS ROMANOS PHARMACY, Petitioner, “em b Ly poe of CASE : vs. O. 02-0878 ey STATE OF FLORIDA, , = AGENCY FOR HEALTH CARE ; ae ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on Mort rar T 2002, 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 7 day of fe Vernbpr _, 2002, in Tallahassee, Florida. Rhonda Wl. Medows, MD, 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Christopher L. Buttermore, Esquire 432 NE Third Avenue Ft. Lauderdale, Florida 33301 (U.S. Mail) Robert E. Meale Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Judy Hefren, Deputy Inspector General Kelly Rubin, Medicaid Program Integrity 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 lp day of Sex cylocke , 2002. Chadene sors 43€Lealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 Romanos Pharmacy Settlement Agreement STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS ROMANOS PHARMACY, Petitioner, vs. CASE NO. 02-0878 PROVIDER NO. 103682300 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA” or “the Agency”), and Romanos Pharmacy (“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 resolving the disputes between them and avoiding the costs and burdens of further litigation. Neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 103682300. 3. In its final agency audit report (final agency action) dated May 22, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI), Office of the Inspector General, indicated that certain claims, in whole or in part, were not covered by Medicaid. The Agency sought recoupment of this overpayment in the amount of $54,424.48. In response to the audit letter dated May 22, 2001, PROVIDER filed a petition ‘ Romanos Pharmacy Settlement Agreement for a formal administrative hearing, which was assigned DOAH Case No. 02- 0878. 4. Subsequent to the audit, during discovery and preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the provider. As a result, AHCA determined that the overpayment was $9,945.85. Specifically, PROVIDER submitted additional documentation, which was reviewed and resulted in an adjustment of the recoupment demand to $54,227.00. In a second submission, more documentation was submitted and reviewed, adjusting the demand to $36,294.77. On August 29, 2002, PROVIDER supplied additional information, further adjusting the overpayment, including costs and fees ($4,000.00) to a total of $9,945.85. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from this MPI review. (2) Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of nine thousand nine hundred forty five dollars and eighty-five cents ($9,945.85) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case Romanos Pharmacy Settlement Agreement No. 02-0878). As a sanction, MPI will do a re-audit of PROVIDER in 6 months. 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.I. 00-1 193-000-3. 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. Alf. <{5}-— PRO At; within thi a 7. «, i » violation -in-the-auudit-period_so that the billing record ts- Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 323 17-3749 PROVIDER agrees that failure to pay any monies due and owing, or to discharge obligations 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. Romanos Pharmacy Settlement Agreement 8. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and any other applicable rules and regulations. 9. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 10. The PROVIDER shall bear its own attorneys’ fees and costs, if any. 11. 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. 12. 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. 13. 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. 14. 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 Romanos Pharmacy Settlement Agreement 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. 15. 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 jaw or rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that it shall 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. 16. 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. 17. 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. 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. Romanos Pharmacy Settlement Agreement 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. ROMANOS PHARMACY Buh fidledeh, ate w/4 “2002 py: FAAUK ) HAL VEA LR (Print name) ITS: Bicahf- Ida, - PRES JEM 7/ OWNER AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Lfotbee Dated: LILT 2002 Rufus Noble ‘ Inspector General Lil fh A E- Dated: di’ L | , 2002 cate Clark Christian General Counsel Dated: l O- WL 02-7002 L. William Porter II Assistant General Counsel ~ i ” Z, / : D + STATE OF FLORIDA / é a all 7 H/ Cy ~AHCA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR LAURA BRANKER, ACTING SECRETARY May 22, 2001 CERTIFIED MAIL _- RETURN RECEIPT NO. 17900 1670 0009 9415 4153 provider No. 1036823 00 License No. PHOO08976 Romanos Pharmacy 9835 W Sample Road Coral Springs, Florida 33065 RE: FINAL AGENCY AUDIT REPORT c.I. No. 00-1193-000-3/H/KDR Dear Provider: an on-site audit of your pharmacy was initiated on March 29, 2000. The audit period was from February 19, 1999, through February 18, 2000. The Florida Medicaid Program through the Agency for Health Care Administration has determined that you have been overpaid $54,424.48 in connection with claims submitted to Medicaid during the audit period. This conclusion is supported by the audit results. This review and the determinations were made in accordance with the provisions of Chapter 409, Florida Statutes (F.S.), and Chapter 59G, Florida Administrative Code (F.A.C.)- In applying for Medicaid reimbursement, providers are required to follow the applicable statutes, rules, Medicaid provider handbooks, statements of Medicaid policy, and federal laws and regulations. Medicaid cannot properly pay for claims that do not meet Medicaid requirements. When a provider receives payment in violation of these provisions, those funds must be repaid. REVIEW DETERMINATIONS The audit included a statistical analysis of a random sampling, with the results applied to the random sample universe of claims submitted during the audit period. The actual overpayment was calculated using 4 procedure that has been proven valid and is deemed admissible in administrative and law courts és evidence of the overpayment. oe 2727 Mahan Drive * Mail Stop #6 Tallahassee. FL 32308 Visit AHCA Online at wow fdie. state fl us Romanos Pharmacy Page 2 Attached are the overpayment calculations, a summary of documented discrepancies, and an itemized listing of discrepancies noted in the review of the random sample. If you accept or concur with these findings, please send your check in the amount of $54,424.48, for the identified overpayment, made payable to the Florida Agency for Health Care administration, to: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 (Note: The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the agency.) To ensure proper credit, be sure that your provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens at (850) 487-4298. You have the right to request a formal or informal hearing pursuant to section 120.569, F.S. If a petition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, F.A.C. Please note that rule section 28-106.201(2), F.A.C., specifies that the petition shall contain a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days of receipt of this letter. Failure to timely request a hearing shall be deemed a waiver of your right to a hearing. tt is important that a request for an informal hearing or a petition for a formal hearing be sent only to the following address: Mr. Charles G. Ginn, Chief Medicaid Program Integrity office of the Inspector General Agency for Health Care Administration 2727 Mahan Drive, Mail Stop # 6 Tallahassee, Florida 32308-5403 Do not send requests or petitions to any other address. Ifa hearing request is not received within 21 days from the date of receipt of this letter, the right to such hearing is waived, and repayment of the above-stipulated overpayment will be due and payable at the end of that 21-day period. Romanos Pharmacy Page 3 Any questions that you may have regarding this matter should be directed to: Kelly Rubin, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive, Mail Stop # 6, Tallahassee, Florida 32308-5403, telephone number (850) 922-4374. - Sincerely, 4 A, (tb — Dp. Kenneth Yon Program Administrator Medicaid Program Integrity DKY /gwm Attachment (s) cc: Medicaid Program Integrity Administrative Section Medicaid Accounts Receivable, Attn: Willie Bivens Heritage Information Systems, Inc. Medicaid Program Development Area Medicaid Office HeritageFinLetRomanosPhy.doc SHLM/01

Docket for Case No: 02-000878MPI