Petitioner: MOUNT SINAI MEDICAL CENTER
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: ERROL H. POWELL
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Jul. 22, 2002
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, January 23, 2003.
Latest Update: Dec. 24, 2024
—————
STATE OF FLORIDA Me
DIVISION OF ADMINISTRATIVE HEARINGS
ra)
MOUNT SINAI MEDICAL CENTER, ae 4
Petitioner, — ere 4,
vs. CASE NO. 02-2904Mp} Ts
STATE OF FLORIDA, ; S
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Respondent.
/
FINAL ORDER
asta ORDER
Agreement on wo Velie 2/ » 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 _~% Vimngor, 2002,
in Tallahassee, Florida.
nA bt
if Rhond - Medows, MD, Secretary
Agency for Health Care Administration
AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY
LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT
TO BE REVIEWED,
Copies furnished to:
L. William Porter II, Esquire
Agency for Health Care
Administration
(Interoffice Mail)
Geoffrey D. Smith, Esquire
Blank, Meenan & Smith
204 S. Monroe Street
Tallahassee, Florida 32301
(U.S. Mail)
Errol Powell
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Judy Hefren, Deputy Inspector General
Debbie Lynn, Medicaid Program Integrity
Willie Bivens, Finance and Accounting
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has
béen furnished to the above named addressees by U.S. Mail on this the _¢ Jiay
, 2002.
Chavlae Thou fas
Uiealand McCharen, Esquire
Agency Clerk
State of Florida
Agency for Health Care Administration
2727 Mahan Drive, Building #3
Tallahassee, Florida 32308-5403
(850) 922-5873
; et
STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
MOUNT SINAI MEDICAL CENTER,
Petitioner,
vs, CASE NO. 02-2904MPI
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(‘AHCA” or “the Agency”), and Mt. Sinai Medical Center (“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 010046300.
3. In its final agency audit report (final agency action) dated May 17,
2002, 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 $147,831.92.
Mt. Sinai Medical Center 02-2904
Settlement Agreement
In response to the audit letter dated May 17, 2002, PROVIDER filed a petition
for a formal administrative hearing, which was assigned DOAH Case No. 02-
2904.
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 $118,127.04.
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 one hundred
eighteen thousand one hundred twenty-seven dollars and
four cents ($118,127.04) plus four thousand four hundred
five dollars ($4,405.00) in costs for a total amount due of
$122,532.04 in full and complete settlement of all claims in
the proceedings before the Division of Administrative
Hearings (DOAH Case No. 02-2904). As a sanction, MPI will
do a re-audit in 6 months.
Mt. Sinai Medical Center 02-2904
Settlement Agreement
(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.1. 01-1 189-000.
(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.
Mt. Sinai Medical Center 02-2904
Settlement Agreement
li. 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, inckuding anyone acting for, associated with or
employed by them, concerning all matters and supersedes any prior
discussions, agreements OF 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.
Mt. Sinai Medical Center 02-2904
Settlement Agreement
20. This Agreement shall be in full force and effect upon execution by
the respective parties in counterpart.
MT. SINAI MEDICAL CENTER
wn Dated: ___/ o/ Ip , 2002
Aluiandw_ A Merde.
(Print name)
its: ___ 82 WA cho:
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
Lefeatlbe. Dated: JY zl , 2002
Rufus Noble
Inspector General
an SLA Lidl GE. Dated: “AI LL , 2002
Valda Ci Clark Christian “—~
General Lounsel
MA Dated: iL , 2002
L. Willi Porter Ww
Assistant General Counsel
FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION
RHONDA M. MEDOWS, MD, FAAFP, SECRETARY
JEB BUSH, GOVERNOR
May 17, 2002
CERTIFIED MAIL ~ 7001 0320 0004 6781 6908
Provider No. 010046300
Ms. Natasha Oyarzun
Director, Performance Improvement
Mt. Sinai Medical Center
4300 Alton Road
Miami, FL, 33140
RE: FINAL AGENCY AUDIT REPORT
C.L. 01-1189-000
Dear Administrator:
Please refer to our provisional agency audit report dated August 15, 2001, wherein we made a
preliminary determination that you were overpaid $147,831.92, for services not covered by
Medicaid. This was based on retrospective medical record review by the Florida Medical
Quality Assurance, Inc. FMQAD), wherein it was determined that either the inpatient admission
or a portion of the length of stay was not medically necessary for Medicaid recipients. We have
received no response from you regarding this provisional agency audit letter. Therefore, the
agency has determined that you were overpaid $147,831.92 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.
ida Administrative Code 59G-4.150 (06/09/96) and Florida Medicaid Hospital
99, Appendix J, under Notice of Adverse Determination,
1 adverse determination was to be made in wmiting to the
Of the attached (see
Pursuant to Flor:
Coverage and Limitations, January 19
request for reconsideration of an initia.
PRO within sixty calendar days after receipt of the denial notice.
2727 Mahan Drive * Mail Stop #6 Visit AHCA online at
won fdhe. state fl.us
Tallahassee, FL 32308
Mt. Sinai Medical Center
Page 2
ing to our records your hospital did not submit a timely
request for reconsideration by Florida Medical Quality Assurance, Inc. (FMQAI) on 0 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 FMQAI’s termination of their Medicaid contract
with AHCA, adverse determinations that were dated for June thru September 1999 will be
granted hearing rights. For the remaining claim(s), you have the right to request a formal or
informal hearing pursuant to section 120.569, FES. 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), FA.C., specify 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 petition must be received within twenty-one (21) days of receipt of this
letter, and failure to timely request a hearing shall be deemed a waiver of your right to a hearing.
attachment) claim(s) reviewed, accord
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 Inspector General
Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #6
Tallahassee, Florida 32308-5403
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, and repayment of the above stipulated overpayment will be due and payable at the end
of that twenty-one (21) day period.
overpayment, please send your check in the amount shown
in the first paragraph of this letter. 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:
If you concur with the amount of the
Agency for Health Care Administration
Medicaid Accounts Receivable
Attention: Ms. Willie Bivens
P.O. Box 13749
Tallahassee, Florida 32317-3749
within 30 days of receipt of this letter, the Agency
dance with the provisions of Chapter 409.913(26),
e directed to Ms. Willie Bivens, Medicaid Accounts
If payment is not received or arranged for,
may withhold Medicaid payments in accor
F.S. Questions regarding payment should b
Receivable, (850) 487-4298.
Mt. Sinai Medical Center a
Page 3 t
this matter should be directed to: Debbie Lynn, Human
‘are Administration, Medicaid Program
Florida 32308, telephone (850) 488-8194.
Any questions you may have about
Services Program Specialist, Agency for Health C
Integrity, 2727 Mahan Drive, MS #6, Tallahassee,
Sincerely,
Wl as
Mike Morton
AHCA Administrator
MVM:djl
Enclosures
ce: Medicaid Program Development
Area Medicaid Office
Willie Bivens
Medicaid Accounts Receivables
MT. SINAJ HOSPITAL
FMQAI Hospital Denials
Provider No, 0100463 00
ADM! DISCHARG DENIAL
RECIPIENT NO LAST NAME FIRST NAME all DATE E BEGIN ene Dave oe OVERPAYMENT
DATE
ADVERSE DETERMINATION - (June - September 41999) LENGTH OF STAY/ADMISSION DENIAL
1881689123 Aguirre Yoselin 12/03/1998 12/05/1998 12/04/1998 12/05/1998 1 $995.58
8134143512 Akanaga Mecha 10/09/1998 10/19/1998 10/13/1998 = 10/19/1 998 6 $5,973.48
7594166451 Atamino Irene ogvo7/1998 09/08/1998 09/07/1998 09/08/1 998 1 $995.58
1189494027 Alonso Blanca 10/04/1997 10/09/1997 10/08/1997 10/09/1997 1 $1,001.59
3742020021 Andino Rubenia oaoe/1997 08/14/1997 08/06/1997 08/14/1997 8 $8,012.72
3742020021 Andino Rubenia 02/11/1999 02/21/1999 02/15/1999 02/21/1 999 6 $6,401.88
7676968771 Arce Marisol 12/10/1997 12/15/1997 12/14/1997 12/15/1997 1 $1,001.59
7588090847 = Beniaminov Irene 10/24/1998 10/26/1998 =: 10/24/1998 10/26/1998 2 $1,991.16
1974699013 Bilboat * Huilian 10/24/1998 10/27/1998 =: 10/24/1998 10/27/1998 3 $2,986.74
7652319773 Bonet Miriam 02/16/1999 02/19/1999 02/17/1999 02/19/1999 2 $2,133.96
1446831973 Burgos Sharon 03/27/1998 03/27/1998 03/27/1998 03/27/1998 1 $981.82
1975328027 Dancy Kimbeny ozoai998 o2/12/1998 02/10/1998 02/12/1 998 2 . $1,963.64
7429242146 Davis-Gorley Janie 01/16/1999 01/20/1999 01/17/1999 01/18/1 999 1 $1,066.98
7463478068 Echeverri Julio 0109/1999 01/12/1999 1/09/1999 O1/12/1 999 3 $3,200.94
7686851133 Ellison Frank 08/23/1997 08/24/1997 08/23/1997 08/24/1997 1 $1,001.59
3765199028 Estrada Maria 01/19/1998 01/22/1998 = 01/21/1998 01/22/1998 1 $981.82
1121667112 Felton Exavier 42/24/1997 01/01/1998 +=: 12/29/1997 01/01/1998 2 $2,003.18
8143474755 Fernandez Jesus 06/19/1998 07/10/1998 06/22/1998 07/10/1998 18 $17,672.76
1691345024 Fesser Maggie 01/25/1997 12/29/1997 12/28/1997 12/29/1997 1 $1,001.59
8100667209 =‘ Flattery Charlotte 02/27/1998 03/03/1998 02/27/1998 03/03/1998 4 $3,927.28
8100667209 ——Flattery Charlotte 05/19/1998 05/28/1998 05/19/1998 05/28/1998 9 $8,836.38
8121298148 Foster Eula 03/29/1999 04/01/1999 03/31/1999 04/01/1999 1 $1,066.93
7424154745 Fuentes Cynthia 01/20/1999 02/02/1999 02/01/1999 02/02/1999 1 $1,066.98
7526591052 Ghuri Jacob 05/27/1998 06/17/1998 06/05/1998 06/17/1998 12 $11,781.84
0860896021 Goa Edith 06/24/1998 06/25/1998 06/24/1998 06/25/1998 1 $981.82
2656439868 Hayden James 04/03/1998 04/10/1998 04/04/1998 = 04/10/1 998 6 $5,890.92
2133021841 Lotman Sophie 02/17/1998 02/19/1998 02/17/1998 02/19/1998 2 $1,963.64
0106828029 = Milton Flora 08/08/1997 08/16/1997 08/10/1997 08/16/1997 6 $6,009,54
1973144026 Pena Rosa 02/25/1999 03/03/1999 02/28/1999 03/03/1999 3 $3,200.94
3001833114 Ponte Tainy 04/01/1998 04/03/1998 =—-04/01/1998 04/03/1998 2 $1,963.64
7509105269 Roggiero Carlos 03/06/1998 03/11/1998 03/06/1998 03/07/1998 1 $981.82
7629956231 Shapiro David o1/s6/1998 01/23/1998 01/22/1998 01/23/1998 1 $981.82
8103304425 Shorts Sydney _ 05/27/1998 06/01/1998 05/28/1998 06/01/1998 4 $3,927.28
2640650998 . Smith Debra 03/27/1998 04/03/1998 03/27/1998 03/31/1998 4 $3,927.28
8117323711 Sporn Barbara 10/21/1998 10/29/1998 10/26/1998 10/29/1998 3 $2,986.74
8105329760 Steiner Rose 03/21/1998 03/23/1998 += -03/21/1998 03/23/1998 2 $1,963.64
3742446029 = Trujillo Sem Diana 01/21/1999 01/25/1999. 01/23/1999 01/25/1999 2 $2,133.96
8125703063 Valdes Pedro 08/23/1998 08/25/1998 08/23/1998 08/25/1998 2 $1,991.16
7712710759 += Vargas Vanessa 04/22/1998 08/06/1998 05/04/1998 05/06/1998 2 $1,963.64
Raisa 40/07/1998 10/29/1998 = 10/10/1998 10/29/1998 19 $18,916.02
7447268372 Yanovskaya
$147,831.92
FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION.
JEB BUSH, GOVERNOR RHONDA M. MEDOWS, MD, FAAFP, SECRETARY
PLEASE INCLUDE THIS REMITTANCE FORM WITH YOUR PAYMENT
Date: May 17, 2002
C.L.No.: 01-1189-000
Provider No. 010046300
Name of Entity: Mt. Sinai Medical Center
4300 Alton Road
Address:
Miami, FL, 33140
Payment Due to the Agency for Health Care Administration:
Managed Care Fine *
$147,831.92 Medicaid Overpayment
Medicaid Fine
Investigative Cost
Other
—— vor oaaaaaa
SEND PAYMENT TO:
Notice of Intent - MC&HQ
Final Order - MC&HQ
Administrative Complaint -MC&HQ
Agency for Health Care Administration
Medicaid Accounts Receivable
Attention: Willie Bivens
P. O. Box 13749
Tallahassee, Florida 32317-3749
Amount Enclosed:
Attorney: NA
Preparer: MPI, djl
Investigator: Debbie Lynn,
Human Services Program Specialist
Visit AHCA online at
wun fditce. state fl us
2727 Mahan Drive * Mail Stop #6
Tallahassee, FL 32308
SS Bt RES NSU ee
7001 0320 OOO4 b78) 6408
CERTIFIED ‘Mail, RECEIP
(Domestic Mall Only; No Insure I
Postage Ts
Certified Fee }
-
Return Receipt Feo
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required}
total Ms. Natasha Oyarzun
Sette Director, Performance Improvement
, Mb. Siani Medical Center
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Docket for Case No: 02-002904MPI
Issue Date |
Proceedings |
Jan. 23, 2003 |
Order Closing File issued. CASE CLOSED.
|
Dec. 06, 2002 |
Final Order filed.
|
Oct. 03, 2002 |
Order Granting Continuance issued (parties to advise status by December 17, 2002).
|
Oct. 02, 2002 |
Joint Motion to Hold Case in Abeyance (filed by Respondent via facsimile).
|
Sep. 20, 2002 |
Respondent`s Witness and Exhibit List (filed via facsimile).
|
Sep. 18, 2002 |
Respondent`s First Interrogatories to Petitioner (filed via facsimile).
|
Sep. 18, 2002 |
Respondent`s Expert Interrogatories to Petitioner (filed via facsimile).
|
Sep. 18, 2002 |
Petitioner`s Answers to Respondent`s Request for Production of Documents (filed via facsimile).
|
Sep. 18, 2002 |
Petitioner`s Answers to Respondent`s Request for Admissions (filed via facsimile).
|
Sep. 05, 2002 |
Order Granting Continuance and Re-scheduling Hearing issued (hearing set for October 17, 2002; 9:00 a.m.; Tallahassee, FL).
|
Sep. 04, 2002 |
Unopposed Motion for Continuance (filed by Petitioner via facsimile).
|
Aug. 15, 2002 |
Amended Order of Pre-hearing Instructions issued.
|
Aug. 06, 2002 |
Order of Pre-hearing Instructions issued.
|
Aug. 06, 2002 |
Notice of Hearing issued (hearing set for September 20, 2002; 9:00 a.m.; Tallahassee, FL).
|
Aug. 01, 2002 |
Notice of Service of Interrogatories, Request for Admissions & Request for Production of Documents (filed via facsimile).
|
Aug. 01, 2002 |
Notice of Service of Interrogatories, Request for Admissions & Request for Production of Documents (filed by Respondent via facsimile).
|
Jul. 29, 2002 |
Joint Response to Initial Order (filed via facsimile).
|
Jul. 22, 2002 |
Final Agency Audit Report filed.
|
Jul. 22, 2002 |
Petition for Formal Hearing filed.
|
Jul. 22, 2002 |
Notice (of Agency referral) filed.
|
Jul. 22, 2002 |
Initial Order issued.
|