STATE OF FLORIDA JUL 12 ag AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, i CLERC AGENCY FOR HEALTH CARE ADMINISTRATION, »¥ fl Bios CASE NO, 02-0951MPI Vahey vs. CI No.: 00-0046-000-WGS/SRE2, A Ne MOBILE X-RAY SPECIALISTS, INC., Provider. / FINAL ORDER Having reviewed Final Agency Audit Report issued to Mobile X-ray Specialists, Inc. (“Provider”), a copy of which is attached ard incorporated as Exhibit “1,” together with the file in this case, the Agency for Health Care Administration (“Agency”) makes the following findings of fact, conclusions of law, and final order. FINDINGS OF FACT 1. From January 1, 1999, through December 31, 1999, Provider was authorized to furnish certain goods and services to Medicaid recipients and receive payment under provider number 030307100. 2. On July 29, 1999, the Agency entered into an Emergency Loan Agreement with Provider and advanced Provider $50,000, to be credited against subsequently allowed Medicaid claims from the Provider. 3. On August 11, 1999, the Agency advanced Provider an additional $50,000 under the same terms and conditions under the Emergency Loan Agreement. 4. Subsequent to the advances made under the Emergency Loan Agreement the Medicaid Contract Management Office completed reprocessing the claims submitted by Provider for the period January, 1999 through December, 1999. According to this reprocessing, $74,623.05 of the claims submitted did not meet the applicable law and guidelines for payment under the Medicaid program. 5. On December 28, 2001, the Agency issued Final Agency Audit Report CI No.: 00-0046-000-WG5/SRF, advising Provider that from the total advances of $100,000 made under the Emergency Loan Agreement the amount of Seventy Four Thousand Six Hundred Twenty-Three and 05/100 Dollars ($74,623.05) remained in default. 6. The Final Agency Audit Report was sent by certified U.S. Mail, return receipt requested, to the Provider’s mailing address on file with the Agency, and was received on January 2, 2002. 7. On January 14, 2002, counsel for Kevin McDonough, former president of Provider, requested a formal hearing pursuant to §120.57(1), Florida Statutes. 8. On February 22, 2002, AHCA referred this matter to the Division of Administrative Hearings for assignment to an Administrative Law Judge. 9. Kevin McDonough is not the Provider. 10. Provider did not file a response to the Final Agency Audit Report. 11. By Order dated April 8, 2002, the Division of Administrative Hearings granted the Agency’s Motion, relinquished jurisdiction back to the Agency, and closed its file. CONCLUSIONS OF LAW A. The Agency for Health Care Administration is that sole agency of the State of Florida responsible for administering the Medicaid program. §409.902, Fla. Stat. (2001). B. Kevin McDonough is not the Provider and is not a person whose substantial interests would affected by the proposed Agency action. §120.569(1), Fla. Stat. (2001). C. By failing to request a hearing or otherwise respond to the Final Agency Audit Report, Provider has waived its rights to a hearing. §120.569(2), Fla. Stat. (2001). Dz. As an authorized Medicaid provider, the Provider was entitled to submit true and accurate claims to the Agency or its agents for goods and services provided under the Medicaid program to eligible recipients. §$409.901, 409.913(7), Fla. Stat. (2001). E. Receiving an advance of Medicaid funds pursuant to the Emergency Loan Agreement for which valid claims were not submitted to the Agency constitutes an overpayment to Provider under the Medicaid program. §409.913(d), Fla. Stat. (2001). F, The Agency is entitled to recover the overpayments made to Provider together with interest from December 28, 2001 (the date of final determination) at the statutory rate of 10% per annum. §§409.913(14) & 409.913(24)(b), Fla. Stat. (2001). ORDER Based on the foregoing findings of fact and conclusions of law, it is ORDERED that Mobile X-ray Specialists, Inc., shall pay the Agency for Health Care Administration Seventy Four Thousand Six Hundred Twenty-Three and 05/100 Dollars ($74,623.05), together with statutory interest which shall accrue until paid, no later than thirty (30) days from the date of this Final Order. CHECKS PAYABLE TO: AGENCY FOR HEALTH CARE ADMINISTRATION SEND DIRECTLY (WITH CASE NUMBER REFERENCED) TO: Willie Bivens Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308 Unpaid amounts will be subject to statutory interest and may be collected by all methods legally available. DONE and ORDERED at Tallahassee, Leon County, Florida this 25 day of Tone , 2002. f° fl MD Secretary Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY FOR HEALTH CARE ADMINISTRATION AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, IN THE DISTRICT COURT OF APPEAL 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 THIRTY (30) DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Edward Livingston, Esq. Edward Livingston, P.A. 628 Ellen Drive Winter Park, FL 32789 (U.S. Mail) Mobile X-Ray Specialist, Inc. 1640 Myrtle Lake Hills Road Longwood, Florida 32750 Eric H. Miller, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice Mail) Willie Bivens Finance & Accounting (Interoffice Mail) Daniel Manry Administrative Law Judge DOAH, The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 CERTIFICATE OF SERVICE a RN EE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served on the above-named persons by U.S. Mail or interoffice mail as indicated on this the {2 day o ~ , 2000. Pee acoxtreaas: \ Dulbcom SR Eeat'and McCharen, Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA ~AHCA AGENCY FOR HEALTH CARE ADMINISTRATION JES BUSH. GOVERNOR RHONDAM MEDOWS, MOF AFP. SECRETARY December 28, 2001 CERTIFIED MAIL - RETURN RECEIPT No. 7000 1670 0009 4949 1807 Provider No. 030307100 Mobile X-Ray Specialist Kevin McDonough 1640 Myrtle Lake Hills Road Longwood, Florida 32750 In Reply Refer to FINAL AGENCY AUDIT REPORT CL. 00-0046-000-WG5/SRF Dear Provider: The Medicaid Contract Management office has completed reprocessing your claims for dates of service January 1999 through December 1999. Based on the claims reprocessing, We have made 4 final determination that you remain in default of your Emergency Loan agreement made on July 29,1999 and August 11,1999 in the amount of $74,623,05. (Please see the attached letter to you dated‘October 5, 2000,from John Owens and the e-mail from Contract Management.) This review and the determinations of overpayment were made in accordance with the provisions of Section 409.913, Florida Statues. In determining payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, i imitati exclusions found in the Medicaid provider handbooks. In applying for Medicaid reimbursement, providers are required to follow the guidelines set forth in the applicab fee schedule, as promulgated in the Medicaid policy handbooks and billing bu cannot pay for services that do not meet these guidelines. If you have any questions about this matter, contact: Sara Frederick, Registered Nurse Consultant, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive MS6Tallahassee,Florida 32308-5403, telephone (850)-413-9280. If you concur with the amount of the overpayment, send your check for $74,623.05. The check must be made payable to the Florida Agency for Health Care Administration, not to any employce of the agency. To ensure proper credit, be certain your provider number is shown on your check. Visit AHCA online al 2727 Mahan Drive « Mail Stop 46 www fdhe. state fl us Tallahassee, FL 32308 Page 2 Mobile X-Ray Specialist Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable P.O. Box 13749 Tallahassee, Florida 32308-3749 Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts receivable, (850)- 921 -4396 ‘You have the right to request a formal or informal hearing pursuant to Section 120.569,F.S. Ifa etition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201 Florida Administrative Code. Please note that rule section 728-106-201 (2) 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 Of petition must be received within twenty —one (21) days of receipt of this letter. Failure to timely request @ hearing shall be deemed a waiver of your right to a hearing. It is important that a request for an informal hearing or 2 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 9727 Mahan, Drive Mail Stop #6 Tallahassee, Florida 32308-5403 Do not send request or petitions to any other address. Ifa hearing request is not received within twenty-orle (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 twenty-one (21) day period. fa timely request hearing request is not received, if it is received and subsequently withdrawn by you, and repayment is not made by that time, an interest penalty of ten percent | 10%) a year from the date of the final agency action shall be imposed in accordance with the provisions of section 409.913, F.S. i \ Sincere Ys Mak ik Administrator Medicaid Program Integrity MM: Enclosures CC: Medicaid Accounts Receivable Medicaid Program Development Medicaid Program Integrity Administration Medicaid Program Integrity Work Group 5 ‘Area Medicaid Office

Docket for Case No: 02-000951MPI