FILEB STATE OF FLORIDA DEC -3 02 DIVISION OF ADMINISTRATIVE HEARINGS CA DEPARTMENT C SOUTH BEACH MATERNITY CLERK ASSOCIATES, Petitioner, Pu booed vs. CASE NO. 02-1594 OU STATE OF FLORIDA, ae AGENCY FOR HEALTH CARE po ADMINISTRATION, * Respondent. a = / : FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on ov !9, 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 / ” day of eversbe’ , 2002, in Tallahassee, Florida. Rhonda M. 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 I], Esquire Agency for Health Care Administration (Interoffice Mail) Alan J. Huber, Vice President Miami Beach Maternity Center 1259 Normandy Drive Miami Beach, Florida 33141 (U.S. Mail) Patricia Malono Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Judy Hefren, Deputy Inspector General Sharon Dewey, 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 SF day RY Lealand Glavine Wipf pse Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 of , 2002. STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS SOUTH BEACH MATERNITY ASSOCIATES, Petitioner, vs. CASE NO. 02-1594 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA” or “the Agency”), and South Beach Maternity Associates (“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 690012700. 3. In its final agency audit report (final agency action) dated February 14, 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 $9,000.00. In response to the audit letter dated February 14, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 02-1594. 4. Subsequent to the original audit that took place in this matter and in 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 $8,000.00. 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 the MPI review. (2) Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of eight thousand dollars ($8,000.00) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 02-1594). As a sanction, MPI will do a re-audit in 6 months. (3) 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. 01-0462-046. (4) 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. 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 7. 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 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. 8. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all 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. Each party 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 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 law 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. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. SOUTH BEACH MATERNITY ASSOCIATES Le... Dated: O cf 2 Ly 22002 ft J WIG ese (Print name) ITS: _Vlcx« fb ESE AT AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Lafrdb pated: /7// , 2002 Rufugy Noble Inspector General Avia ME pated: _@-_ /Y , 2002 Valda Clark Christian General Counsel *‘ “Aw lyn ie Dated: I(- Z "__, 2002 L. William Porter II Assistant General Counsel STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RUBEN J. KING-SHAW, JR., SECRETARY Cp February 14, 2001 ire Wer CERTIFIED MAIL-RETURN RECEIPT REQUESTED 7001 0360 0003 15606796 Provider No. 690012700 SOUTH BEACH MATERMITY ASSOCN. DBA MIAMI BCH MATERNITY CTR 1259 NORMANDY DRIVE MIAMI BEACH, FL 331410000 - In Reply Refer to FINAL AGENCY AUDIT REPORT C.1. 01-0462-046/WG 2/SJD Dear Provider: The Medicaid Program Integrity office has completed a review of Medicaid claims for the procedures specified below for dates of service during the period July 1, 1996 through January 31, 2001. Based on this review, we have made a determination that you were overpaid $9,000.00 for claims that in whole or in part are not covered by Medicaid. This review and the determinations of overpayment were made in accordance with the provisions of Section 409.913, Florida Statutes. In determining payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies and the limitations and exclusions found in the Medicaid provider handbooks. In applying for Medicaid reimbursement, providers are required to follow the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks and billing bulletins. Medicaid °» “cannot pay for services that do not meet these guidelines. Below is a discussion of the particular guidelines related to our review of your claims and an explanation of why these claims do not meet Medicaid requirements. An attached computer printout lists the claims that are affected by this determination. Visit AHCA Online at 2727 Mahan Drive » Mail Stop #6 www. fdhe.statefl.us Tallahassee, FL 32308 Final Agency Audit Report Letter Page 2 “Medicaid reimburses licensed midwives and birth centers for procedure code X5907 labor management for recipients who labor at home or at the birth center and are then transferred to the hospital for delivery.” 1. You billed and received payment for procedure code X5907 labor management services when the recipient delivered at home and or at a birth center without being transferred to the hospital. This amount is considered an overpayment. If you concur with the amount of the overpayment, send your check for $9,000.00. 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 certain your provider number is shown on your check. Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts -ecelvable, (850) 921-4396. You have the right to request a formal or informal hearing pursuant to section 120. 569, FS. Ifa yetition for formal hearing is made, the petition must be made in compliance with rule section 18-106.201, F.A.C. Please note that rule section 28-106. 201(2), F.A.C., specifies that the Jetition shall contain a concise discussion of specific items in dispute. Additionally you are \ereby informed that if a request for a hearing is made, the request or petition must be received vithin twenty-one (21) days of receipt of this letter. . t is important that a request for an informal bearing or a petition for a formal hearing | be ent only to the following address: Mr. Charles G. Ginn, Chief Medicaid Program Integrity Office of Inspector General Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308-5403 io not send requests or petitions to any other address. Ifa hearing request is not received within venty-one (21) days from the.date of receipt of this letter, the right to such hearing is waived, id repayment of the above stipulated overpayment will be due and payable at the end of that venty-one (21) day period. Final Agency Audit Report ‘ter Page 3 If you have any questions about this matter, contact Sharon Dewey, Registered Nursing Consultant, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive, Mail Stop 6, Tallahassee, Florida 32308-5403, telephone (850) 410-0759, Sincerely, Williams AHCA Administrator SAW:SJD:em Enclosures _ ce: Medicaid Accounts Receivable Medicaid Program Development Medicaid Program Integrity Administration Medicaid Program Integrity Work Group Five Area Medicaid Office

Docket for Case No: 02-001594MPI