~ EE riled) STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION APR -2 93 CEPA ate ae CLERK Zs, NORTH FLORIDA REGIONAL MEDICAL CENTER, Petitioner, , + on DOP Clie vs. _ CASE NO. 02-1979MPI o Rrdtion [pe AHeA-C3 -L3TS- MDP \ o 3 _ 2 “ 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 “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the Z/ — day of Wh , 2003, in Tallahassee, Florida. Rhofda M 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: Pamela G. Zahler General Counsel HCA Healthcare, Patient Account Services Orange Park P.O. Box 1627 Orange Park, Florida 32067 ‘Kim A. Kellum, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 D.W. Davis ‘Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and Accounting , CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished 3° the above named addressees by U.S. Mail on this the day of 4 DEC oy 2003. harlow Saupscr fol Lealand McCharen, Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA: ;- AGENCY FOR HEALTH CARE ADMINISTRATION 22 e NORTH FLORIDA REGIONAL MEDICAL CENTER, Petitioner, ys. CASE NO.: 02-1979MPI STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT ee ee eee Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, North Florida Regional Medical Center, by and through the undersigned individuals, hereby stipulate and agree as follows: 1. This settlement agreement is entered into between the ‘ parties in order to resolve a dispute that arose as the result of a KePRO audit. 2. Ina final agency audit letter dated March 4, 2002, Petitioner was informed that the Agency determined that it was overpaid. Consequently, Respondent sought recoupment in the amount of $92,607.17. Attached as exhibit “A” is the overpayment letter and the subsequent reconsideration and settlement figures. ° 3. In a petition dated March 25, 2002, Petitioner challenged Respondent’s action and requested a formal hearing regarding the overpayment., The Petitioner was granted a formal hearing. 4. Subsequently, Respondent reviewed additional documentation regarding the claims in question. After this subsequent review, Respondent recalculated the overpayment ‘amount. 5. Accordingly, Respondent no longer contends that Petitioner owes Respondent $92,607.17. The recalculated overpayment is $61,237.37. 6. Petitioner agrees to pay the Agency $2,952:63 in costs. 6. The Agency agrees to allow the Petitioner, North Florida Regional Medical Center, to pay the Agency the total sum of $64,190 within sixty (60) days of complete execution of the settlement agreement. 7. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 8. In the event the Petitioner fails to make any payment due hereunder, the Respondent may, at its option and upon fifteen days written notice to Petitioner, declare Petitioner in default. Its provider number shall be suspended until such time as the Agency. receives Payment of the balance in full. oe ene re 9. This settlement does not constitute arn admission of wrongdoing or error by either party. However, the parties ' believe that this matter should be settled. 10. Both parties request that the above-referenced file be closed. 11. Each party shall bear its own attorney’s fees and costs. 12. This agreement represents the entire agreement between the parties regarding settlement of this case. 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. The signatories to this agreement, acting in a representative capacity, represent that they are duly authorized to act on behalf of the ‘parties to the agreement. Venue for any action arising from this agreement shall be in Leon County, Florida. 13. Petitioner for itself and for its attorneys, heirs, executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and AHCA’s actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forun, including any claims arising out of this agreement, by or on behalf of Facility. ’ , Dated this Vall day of ylovk: . of. 2003. . 7 ed os eo: e 90 2 - 4 AGENCY, FOR! HBALTH® CARE ADMINISTRATION \ _ » X Valda Clark Christian General Counsel State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Center #1 Florida 32308 State”of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Center #1 Tallahassee, Florida 32308 NORTH FLORIDA REGIONAL MEDICAL CENTER ,. “4 Z ae . S Pamela G. Zahler~ Géneral Counsel HCA Healthcare, Patient Account Services Orange Park P.O. Box 1627 Orange Park, Florida 32067 ~LAHCA AGENCY FOR HEALTH GARE ADAlINISTRATIO‘ RHONDA M. MEDOWS, MD, FAAFP, SECRETARY om 4JEB BUSH, GOVERNOR March 4, 20027” CERTIFIED MAIL —- RETURN RECEIPT NO. 7001 0360 0003 1559 8961 Provider No. 010862600 Ms. Theresa Grant Appeals Manager North Florida Regional Medical Center 6500 Newberry Road Gainesville, FL, 32614 In Reply Refer to: FINAL AGENCY AUDIT REPORT C.L 01-2052-000 ~ Dear Ms. Grant: Please refer to our provisional agency audit report dated January 3, 2002, wherein we made a preliminary determination that you were overpaid $96,210.89, for services not covered by Medicaid. This was based on retrospective medical record review by the Florida Medical . Quality Assurance, Inc. (EMQAN), wherein it was determined that either the inpatient admission or a portion of the length of stay was not medically necessary for Medicaid recipients. In response to the preliminary letter, you sent additional documentation to validate your claims. The agency has performed a subsequent review, in light of the additional evidence you provided. Therefore, it has been determined that you were overpaid $92,607.17 for claims that in whole or in part are not covered by Medicaid. This review and the determination of overpayment were made in accordance with the provisions of Florida Statutes Section 409.913. In determining payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies, Medicaid Bulletins, . Statements of Policy 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. Visit AHCA online at www. fdhe.statefl.us 2727 Mahan Drive © Mai! Stop # Tallahassee, FL 32308 ae eee - mm 1 i ‘ rAaN North Florida Regional Medical Center page 2 ; Pursuant to Florida Administrative Code 5°G-4:150 (G6/C5796) an Florida Medicaid Hospital anuary 1999, Apperdix_I,.under’ Nofice of’Adverse Determination, Coverage and Limitations, J n was to be ‘made in writing to the request for reconsideration of an initial adverse determinatio’ PRO within sixty calendar days after receipt of the denial notice. Of the. attached (see attachment) claim(s) reviewed, according to our records your hospital did not submit a timely request for reconsideration by Florida Medical Quality Assurance, Inc. (FMQAD) on 32 claim(s). Therefore, you waived your rights to an administrative hearing. If you have additional documentation supporting a timely request for reconsideration, please submit within 21 days or submit payment for these claims. Because of FMQAT’s termination of their Medicaid contract with AHCA, adverse determinations that were dated for June thru September 1999 will be ng 1 claim(s), you have the right to request a formal or informal hearing pursuant to section 120.569, F.S. If a request for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, Florida Administrative Code (F.A.C.). If a request for an informal hearing is made, the petition must be made in compliance with rule section 28-106.301, FA.C. Please note that rule section 28-106.201 (formal hearing) and 28-106.301 (informal hearing), EA.C., specify that ‘the petition shall contain a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request ng is made, the petition must be received within twenty-one (21) days of receipt of this granted hearing rights. For the remaini for a heari letter. It 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 i) . . : . Do not send requests or petitions to any other address. If a hearing request is not received within twenty-one (21) days from the date of receipt of this letter, the right to such hearing is waived. nd your check in the amount shown in the le to the Florida Agency for Health Care If you concur with the amount of the overpayment, se r credit, be certain your first paragraph of this letter. The check must be payab Administration, not to any employee of the agency. To ensure prope provider number is shown on your check. Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable Attention: Ms. Willie Bivens P.O. Box 13749 Tallahassee, Florida 32317-3749 North Florida Regional Medical Center page 3 . If payment is not received or arranged for within 30 ‘days of receipt of this is letter, the Agency =7- —-may withhold Medicaid payments in accordance 4with ‘Ke provisions of Chapter 409.913(26), F.S. Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid Accounts Receivable, (850) 487-4298. If you have any questions about this matter, please contact Sue Gibson, Research Assistant, Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahan Drive, MS #6, Tallahassee, Florida 32308, telephone (850) 488-8194. Sincerely, Mike Morton ACHA Administrator MVM:sbg Enclosures” cc: Medicaid Program Development Area Medicaid Office Willie Bivens Medicaid Accounts Receivables eooes . Ci) ° ° evee NORTH FLORIDA REGIONAL MEDICAL CENTER, INC. FMOQAI DENIALS .3 0 OB 7 2 . > eo PROVIDER NUMBER 010862600 7327 3 °e> ° 3s 0 3 3¢ ~~ 2 — ——.—, IALEND DENI DISCHARGE DENIAL DEN AL OVERPAYMENT FIRST RECIPIENTNO LASTNAME =. ADMITDATE D.TeoBEGINDATE DATE DAYS RECONSIDERATION DETERMINATION 8129837099 Frank Johnny 01/12/98 01/19/1998 01/16/1998 01/19/1998 3 $2,070.54 ADVERSE DETERMINATION (June thru September 1999) 2294097122 Blake Roy. 05/22/98 os/04/1998 05/02/1998 05/03/1998 1 $690.18 4163459707 Blount Mallie 122297 1231/1997 12/24/1997 12/31/1997 7 $5,187.84 2033496023 Chery Sharon 406/25/97 07/11/1997 07/07/1997 07/11/1997 4 $2,920.80 8112907242 Chewning Brandy 06/05/98 06/13/1998 06/11/1998 06/13/1998 2 $1,380.36 876620101 Cox Sarah oaos/e9 ‘osa/1999 Ca7/1S99 03/08/1999 1 $745.22 8113051678 Davis Daisy 0429798 05/04/1998 08/01/1998 05/04/1998 3 $2,070.54 7470984070 Davis Daisy 011298 01/21/1998 01/14/1998 01/21/1998 7 $4,831.26 7470984070 Davis Daisy 114197 11/25/1997 11/22/1997 11/25/1997 3 $2,223.36 8126992778 Drawdy Evon oxo4e9 03/07/1999 os/04/1s99 0207/1999 3 $2,232.66 7339634840 Duncan Abra ogeaso koa2e/1999 02/24/1999 09/28/1999 2 $1,490.44 8101063609 Ellenberg Kermit 09/21/98 09/28/1998 os/25/1998 09/28/1998 3 $2,099.91 ' 7479847441 Feliciano — Angela ogso/97 09/03/1987 09/01/1987 09/02/1997 2 $1,482.24 8111633904 Fisher Gina 7220/08 12/28/1998 12/25/1998 12/28/1998 3 $2,062.41 2064923021 Graham —- Wilma ‘osoz/s8 © ofvog/1998 OB/06/1998 06/09/1998 a $2,069.28 8106339700 Harbaugh Ruth 1204/98 12/08/1998 12/06/1998 12/08/1998 2 $1,399.94 1924639021 Harris Leita o1n2ree «01/16/1999 01/12/1999" 01/16/1999 4 $2,980.88 "7336686141 Hill James 1OME/98 10/09/1998. 10/0e/1998. 10/09/1998 3 $2,099.91 “s""4130001877 Jerrels Robert 10/13/97. 10/18/1997 10/18/1997 2 $1,482.24 "7812770545 Johnson —Annatt 07/7/98 07/29/1998 07/22/1998 07/29/1998 7 $4,899.79 : Jones Ester 1112/97,. 11/20/1997. 11/19/1997." 11/20/1997 1 $741.12 “4108247921 Lawson Deamia osge9 03/15/1999 o7/14N1999. Ga/iS/1999 1 $745.22 ° 847979024 Mangham Dora 11N4e7 01/23/1998" 7" 0123/1998 at $30,385.92 "8106268756 Mott Jimmie 1208/98 12/15/1998 12/14/1998 12/18/1998 1 $699.97 7351537208 Nessmith Nancy 0416/98 4=04/19/1998 04/18/1998 04/19/1998 1 $690.18 _ 7690570968 Parker Helen oaig/s7 O825/1997, OB/24/997. OB25/1997 1 $741.12 “9100448141” Rains Scotty 0928/98 09/29/1998 o9/28/1998 09/29/1998 1 $699.97 © 8100448141 Rains Scotty 03/16/98 03/17/1998 03/16/1998 03/17/1998 1 $690.18 " g109531261 Romano Kenneth o1igre9 01/22/1999 01/22/1999 01/22/1999 1 $745.22 1537823027 Sneed Latrelle os/o9B © ov/12/1998 03/08/1998 03/10/1998 2 $1,380.36 _7671993441' Wade Susan o7/22rg7 07/29/1997 07/22/1997. 07/29/1997 7 $5,187.84 7335705541 Wallace Roy 1030/98 11/04/1998 11/01/1998 11/04/1998 3 $2,099.91 7579103541 York William 01707798 +=01/09/1998 01/07/1998 0109/1998 2 $1,380.36 : $92,607.17 —— tA FS [RGENET FOR WEALTH CARE ADMINISTRATION 7? FONDA Mt. menows, MD, FAAFP, SECRETARY JeB BUSH, GOVERNOR Date: January 29, "2002 CL Nox 01-2052-000 Provider No. 010862600..: Name of Entity: North Florida Regional Medical Center Address: 6500 Newberry Road Gainesville, FL, 32614 Payment Due to the Agency for Health Care Administration: “Notice of Intent -MC&HQ — Managed Care Fine Final Order - MC&HQ . $92,607.17 Medicaid Overpayment Medicaid Fine __.__. Administrative Complaint - MC&HQ —. Other Investigative Cost _ SEND PAYMENT TO: Sue Gibson, Research Assistant Visit AHCA online at www. fdhe.state.fl.us RE-CALCULATED RE-REVIEW 10/21/2002 NORTH FLORIDA REGIONAL MEDICAL CENTER, INC. FMQA! DENIALS PROVIDER NUMBER 010862600 RECIPIENT | cr Name FIRST ADMIT DISCHARGE DENIAL DENIAL DENIAL OVERPAYME NO NAME DATE DATE BEGIN DATE END DATE DAYS NT ADVERSE DETERMINATION (June thru September 1999) 2033496023 Cherry Sharon 06/25/97 7/11/1997 TANS97 ~—- 7111/1997 4 $2,920.80 8112907242 Chewning Brandy O6/05/98 6/13/1998 6/12/1998 6/13/1998 1 $690.18 876620101 Cox Sarah 03/05/99 3/8/1999 47/1999 3/8/1999 1 $745.22 8113051678 Davis Daisy 04/29/98 5/4/1998 5/1/1998 5/4/1998 3 $2,070.54, 7470964070 Davis Daisy 01/12/98 1/21/1998 1/18/1998 1/21/1998 3 $2,070.54 7470964070 Davis Daisy 1114197 11/25/1997 11/22/1997 11/25/1997 3 $2,223.36 8126992778 Drawdy Evon 03/04/99 3711999 3/4/1999 4/7/1999 3 $2,232.66 7339334840 Duncan Abra 03/24/99 3/26/1999 3/24/1999 3/26/1999 2 $1,490.44 8101063609 Ellenberg Kermit 09/21/98 9/28/1998 9/25/1998 9/28/1998 3 $2,099.91 7479847441 Feliciano éngela 08/30/97 9/3/1997 9/1/1997 9/3/1997 2 $1,482.24 2064923021 Graham ‘Wilma 06/02/98 6/9/1998 6/6/1998 6/9/1998 3 $2,069.28 8106339700 Harbaugh Ruth 12/04/98 12/8/1998 12/7998 12/8/1998 1 $699.97 1124639021 Harris Leila oi2e9 = 1/16/1999 421999 1/16/1999 4 $2,980.88 1130001577 Jerrels ' Robert 10/13/97 10/18/1997 10/16/1997 10/18/1997 2 $1,482.24 7512770545 Johnson Annett 07/17/98 = 7/29/1998 7/22/1998 7/29/1998 7 $4,899.79 1999033027 Jones Ester 11/12/97 11/20/1997 11/19/1997 11/20/1997 1 $741.12 4105247921 Lawson Deamia 03/09/99 3/15/1999 3/14/1999 = 3/15/1999 1 $745.22 847979024 Mangham Dora VN397— 1/23/1998 = 11/13/1997 = 1/23/1998 41 $30,385.92 7351537208 Nessmith Nancy 04/16/98 4/19/1998 4/18/1998 4/19/1998 1 $690.18 8100448141 Rains Scotty 09/28/98 9/29/1998 9/28/1998 9/29/1998 1 $699.97 8109531261 Romanc Kenneth 01/19/99 1/22/1999 1/22/1999 1/22/1999 1 $745.22 1537823037 Sneed Latretie 03/08/98 3/12/1998 3/8/1998 3/10/1998 2 $1,380.36 7671993441 Wade Susan 07/22/97 = 7/29/1997 7/22/1997 = 7/29/1997 7 $5,187.84 7335705541 Wallace Roy 10/30/98 11/4/1998 11/3/1998 11/4/1998 1 $699.97 7579103541 York William 01/07/98 1/9/1998 1/7/1998 1/9/1998 2 $1,380.36 $72,814.21 18/38/2882 17:23 16886746 NORTH FLORIDA REGIONAL MEDICAL CENTER FMQAI DENIALS - SETTLEMENT ACCOUNTS - RERUNI! FIFTY PERCENT 876620101 7339334840 74796474414 2064923021 1124639021 1130001577 7512770545 7351537208 2109531261 1537823027 7671993444 Cox Duncan Feliciano Graham Harris Jerrels Johnson Nessmith Romano Sneed Wade Sarah Abra Angela Wilma Leila Robert Annet Nancy Kanneth Latrelie Susan ow0s/9s 02/24/98 O&/30/S7 06/02/98 01/12/99 10/13/07 07/17/98 04/16/98 0119/99 03/08/98 o7f22/87 27aig99° 3/26/1999 9731997 6/9/1998 1/18/1999 10/18/1997 7/29/1998 4/19/1898 1/22/1999 3/12/1998 F2U1S97 4711999 3/8999 2/24/1999 3/26/1999 9/1/1997 9/3/1997 Ge/is98 6/9/1988 Wi2ig99 = 1/16/1999 10/16/1987 10/12/1997 7/22ne98 = 7/29/1998 4/18/1998 4/19/1998 1/22/1999 1/22/1999 eigee 10/1998 72nigs7 = 7/29/1997 TIMES S0% = NNSA NN ROD DO $745.22 $1,490.44 $1,482.24 $2,069.28 $2,980.88 $1,482.24 $4,899.79 $690.18 $745.22 $1,380.26 $5,187.34 $23,153.69 $11,576.85 48/30/2082 17:23 16885748 HCA HEALTHCARE t NORTH FLORIDA REGIONAL MEDICAL CENTER FMQAI DENIALS - REFUNDS THAAN9S7 TANGST §=—-7/1111997 2033496023 Chery Sharon 06/25/97 8112907242 Chewning = Brandy oeos9s 8/13/1998 )§=-G/12/199B = 6/1/1998 8113051678 Davis Daisy 04/29/98 S4i1998 8=—-S1/1998 =—-- 5/4/1998 7470964070 Davis Daisy 01/12/98 «91/21/1998 = 1/18/1998 = 1/21/1998 7470864070 Davis Daisy 147 §« 11/25/1997 11/Z2/199T =: 11/25/1997 8126992778 Drawdy Evon 03/04/93 27H999 4/1999 3/7/1989 8101063609 Ellenberg Kermit 092198 9/28/1998 9/25/1998 9/28/1998 6106339700 Harbaugh Ruth 4Zosses §=—- 12/8/1998 «= 12/7/1998 =: 12/8/1998 1999033027 Jones Ester W297 «11/20/1987 11/19/1997 11/20/1987 4105247921 Lawson Oeamia ovoges 3/15/1999 3/14/1999 3/18/1989 847979024 Mangham Oora +1497 © -1723/1998 «11/12/1997 1/23/1998 8100445141 Rains Scotty og2a98 9/29/1998 1 w92e/1998 9/29/1996 7335705541 Wallace | Roy 40/398 11/4/1898 17/3/1996 11/4/1998 7579103541 York Wiliam 007/98 1/9/1998 1711998 9/1988 $2,920.80 $690.18 $2,070.54 $2,070.54 $2,223.36 $2,232.66 $2,099.91 $699.97 $741.12 $745.22 41 = $30,385.92 $699.97 $699.97 “A= 20 WY WW Waa nw ow $1,380.36 $49,660.52 North Florida Regional Medical Center Accounts Reconsidered and allowed Name Finai Overpayment Amount Johnny Frank $0 Roy Blake $0 Mallie Blount $0 Gina Fisher $0 James Hill $0 Jimmie Mott $0 Helen Parker $0

Docket for Case No: 02-001979MPI