‘ FILED STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AUS 16 02 FLAGLER HOSPITAL, Petitioner, > DOAH CASE NO: 02-1311M2E3_; v. JUDGE: Ella Jane P. s< AGENCY FOR HEALTH CARE clo2elf 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 / 3 day of Agesf , 2002, in Tallahassee, Florida. . r Rhonda uD edows, 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: Ernie Meyers 701 Peachtree Rd. Orlando, FL 32804 Kelly Bennett, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Sue Gibson Medicaid Program Integrity 2002 Old St.Augustine Rd. Bldg. D MS# 6 Tallahassee, FL Charlie Ginn Medicaid Program Integrity 2002 Old St. Augustine 1 Rd. Bldg. D MS# 5 Tallahassee, FL Willie Bivens, Finance and Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished tor ,the above_named addressees by U.S. Mail on this the L{ gt day of AUC IGE , 2002, Ch neléme TROD S$ @agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 Flagler Hospital DCH Case No.: 02-1311 : Page | of 4 0. é < Up & STATE OF FLORIDA , lo ~ QO DIVISION OF ADMINISTRATIVE HEARING§/ 77. a Sy WMS: xi. I 5 FLAGLER HOSPITAL, 4p Tp", fon 0 Pa Nosy a Petitioner, DOAH CASE NO: 02-1311MPI v. JUDGE: Ella Jane P. Davis 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 FLAGLER HOSPITAL, (“Petitioner”). 1. This matter arises out of AHCA’s review of Petitioner’s paid claims to Medicaid. On October 12, 2001, AHCA issued a Final Agency Action Letter (FAAL) that determined Petitioner had been overpaid by Medicaid in the amount of $74,529.98. 2. Petitioner filed a petition challenging AHCA’s determination and requesting a formal administrative hearing and requesting a formal reconsideration pursuant to Rule 596- 4.150, Florida Administrative Code (regarding Notices of Adverse Determination). 3. Prior to hearing in this matter, the parties met to exchange documents, review records, and discuss each of the claims at issue. As a result of the aforementioned discussions, the parties agree that the overpayment is at least $24,257.01 and no greater than $49,836.06. 4. In order to resolve this matter without further administrative proceedings, Petitioner has agreed to repay $45,000, and to withdraw its request for administrative hearing with prejudice to refilling the petition. Flagler Hospital DCAH Case No.: 02-1311 Page 2 of 4 5. AHCA agrees to accept $45,000, in the manner set forth herein in settlement of the overpayment issues arising from the Medicaid review (CI. 01-0892-000). 6. Petitioner agrees to pay to AHCA in one lump sum, the amount of forty-five thousand dollars ($45,000), to be paid within thirty (30) days of the issuance of a final order adopting this agreement. 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. 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: C.I. 01-0892-000 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 Payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the C.I. 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. 12. The parties will bear their own fees and costs associated with these proceedings. Flagler Hospital DO.:H Case No.: 02-1311 Page 3 of 4 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. 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. This Agreement constitutes the entire agreement between Petitioner and AHCA, including anyone acting for, associated with or employed by them, concerning all matters 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, 16. 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 tules 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, 17. 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. 18. 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. Flagler Hospital DOAH Case No.: 02-1311 Page 4 of 4 19. This Agreement shall inure to the benefit of and be binding on each party’s Successors, assigns, heirs, administrators, representatives and trustees. FLAGLER HOSPITAL 400 Health Park Blvd. St. Augustine, FL 32086 Dated: 6les Jor , 2002 :___ Joseph S. Gord (print name above) ITS:___ Senior Vice President (print title above) Ly Dated: _7// , 2002 Ernest Myers: Sq. Counsel for Petitioner 701 Peachtree Rd. Orlando, FL 32804 AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 La & ptr Dated: Fy 4d , 2002 Rufus Moble Inspector General EM hefeote Dated: 59,2002 William Roberts Acting/General Counsel Dated: » 2002 Assistant General Counsel

Docket for Case No: 02-001311MPI