STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JACKSONVILLE METHODIST HOME, INC. , d/b/a WESLEY WOODS, Petitioner, DOAH Case. No. 02-2693MPI v. Audit Period: January 31, 2000 Engagement No. NH02-045M STATE OF FLORIDA, Provider No. 212083 , AGENCY FOR HEALTH CARE FR thor Te JP HOR OS "Ol WAS UA ADMINISTRATION, Respondent. FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement which is attached and 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 a “L_ day of ware an 2003, in J ‘reef MD, Se¢retary Agency for Health Care Administration Tallahassee, Florida. 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: Theodore E. Mack, Esquire Powell & Mack 803 North Calhoun Street Tallahassee, Florida 32308 Susan Felker-Little, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 B.J. Staros Administrative Law Judge The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Lisa Milton, Audit Services Administrator Agency for Health Care Administration 2727 Mahan Drive, MS#21 Tallahassee, Florida 32308 Finance and Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been Oy furnished to the above named addresses by U.S. Mail on this the <- l day of Hl. Oe heee oS ; (+ cWle eC Ik eS MO meer ~ ar ot Tealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JACKSONVILLE METHODIST HOME, INC. , d/b/a WESLEY WOODS, Petitioner, DOAH Case. No. 02-2693MPI v. Audit Period: January 31, 2000 Engagement No. NH02-045M STATE OF FLORIDA, Provider No. 212083 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. a SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA or the Agency), and JACKSONVILLE METHODIST HOME, INC., d/b/a WESLEY WOODS (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 avoiding the costs and burdens of litigation. 2. PROVIDER is a Medicaid provider in the State of Florida, operating as nursing home, that was audited by the Agency. 3. The Agency conducted an audit of the PROVIDER’S cost report for the year ended January 31, 2000. JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS v. AHCA January 31, 2000/NH02-045M SETTLEMENT AGREEMENT Page 2 of 7 4. In its Audit Report issued on April 16, 2002, AHCA notified PROVIDER that a review of the PROVIDER’S cost report revealed that, in its opinion, some claims in whole or in part were not reimbursable by Medicaid. The Agency further notified PROVIDER of the adjustment that AHCA was making to its cost report. In response to the Audit Report, PROVIDER filed a timely petition for administrative hearing and the matter was referred to the Division of Administration Hearings for the assignment of an Administrative Law Judge and was assigned DOAH Case No. 02-2693MPI. 5. Subsequent to issuance of the Audit Report, AHCA and PROVIDER exchanged documents and discussed adjustments that were at issue, and DOAH relinquished jurisdiction to AHCA, for the execution of a settlement agreement by all parties. 6. As a result of the aforementioned exchanges, the parties agree that the Agency’s adjustments that were the subject of these proceedings, as they relate to the PROVIDER’S cost report for the audit period ended January 31, 2000, shall be as follows: a. Audit Adjustment #7 will be reduced from ($5,650) to ($1,712). b. Audit Adjustment #9 will be reduced from ($2,365) to ($717). c. Audit Adjustment #21 will be reduced from ($14,607) to ($4,427). d. Audit Adjustment #31 will be reduced from ($44,458) to ($13,474). JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS v. AHCA January 31, 2000/NH02-045M SETTLEMENT AGREEMENT Page 3 of 7 e. Audit Adjustment #32 will be reduced from ($5,964) to ($1,807). f. Audit Adjustment #33 will be reduced from ($3,166) to ($960). g. Audit Adjustment #36 will be reduced from ($2,365) to ($717). 7. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree that the adjustment resolution, as set forth above, will resolve and settle this case completely. As such, this Agreement constitutes PROVIDER’S withdrawal of PROVIDER’S petition for administrative hearing, with prejudice. 8. PROVIDER and AHCA further agree that the Agency shall recalculate the per diem rate for the time period involved in this matter, and issue a notice of the recalculation. Where PROVIDER was overpaid, PROVIDER will remit payment to the Agency in the full amount of the cost within thirty (30) days of such notice. Where PROVIDER was underpaid, AHCA will remit payment to the PROVIDER in the full amount of the underpayment within forty-five (45) days of such notice. 9. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS v. AHCA January 31, 2000/NH02-045M SETTLEMENT AGREEMENT Page 4 of 7 PROVIDER Jacksonville Methodist Home, Inc. d/b/a Wesley Woods 25 William Bartram Scenic HW Jacksonville, FL 32259 Payment shall clearly indicate that it is pursuant to a settlement agreement and shall reference the audit period/engagement number (Audit Period: January 31, 2000/Engagement No. NH02-045M) 10. 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. ; ! 1. PROVIDER and AHCA reserve 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. 12. This Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be settled because the parties have agreed to the terms contained within this Agreement. JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS v. AHCA January 31, 2000/NH02-045M SETTLEMENT AGREEMENT Page $ of 7 13. Each party shall bear its own attorneys’ fees and costs, if any. 14. 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. PROVIDER agrees to forward a copy of this Agreement to AHCA with original signatures, and understands that a Final Order may not be issued until the Agreement with original signatures is received by AHCA. 15. 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. 16. This Agreement constitutes the entire agreement between PROVIDER and 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 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. 17. 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 JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS v. AHCA January 31, 2000/NH02-045M SETTLEMENT AGREEMENT Page 6 of 7 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. 18. 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, other than enforcement of this Agreement. PROVIDER further agrees that it shall not challenge or contest any F inal Order entered in this matter that is consistent with the terms of this 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. 19. 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. 20. 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. 21. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 22. All times stated herein are of the essence of this Agreement. JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS v. AHCA January 31, 2000/NH02-045M SETTLEMENT AGREEMENT Page 7 of 7 23. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. JACKSONVILLE METHODIST HOME, INC. d/b/a WESLEY WOODS Dated: =) / S , 2003 By: Le n. Ke. L_ , (print name rhs Its: _ 1 6esupRee (print title above) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 6a Dated: Ca , 2003 Bob Sharpe Deputy Secretary, Medicaid ye Oy TOK or 0 hla “es Dated: 644 27 2003 Valda Clark Christian General Counsel Dated: LE’ | Z , 2003 Susarc. Felker-Little Assistant General Counsel

Docket for Case No: 02-002693MPI