STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AES ws FMC HOSPITAL, LTD. D/B/A he FLORIDA MEDICAL CENTER Petitioner, ms) VL cloed | ~ DOAH CASE NO. 02-2908MPI * . Vv. AHCA Provider No. 010214800 STATE OF FLORIDA, AGENCY FOR HEALTH CARE 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 7 day of p/ovinebere , 2002, in Tallahassee, Florida. Ahir onda MA. Medows, MD, Secretary i 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: Michael J. Glazer, Esquire Ausley & McMullen. Post Office Box 391 Tallahassee, Florida 32302 Susan Felker-Little, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 John G. Laningham Administrative Law Judge The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Debbie Lynn, Human Services Program Specialist Agency for Health Care Administration 2727 Mahan Drive, MS#6 Tallahassee, Florida 32308 Willie Bivens Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 320308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail on this the { p day of Nex el lick , 2002. _{ Ihaelene | Dou bsor Qf Lealand McCharen, Agency Clerk oe featand for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 From: Bennett, Kelly Sent: Tuesday, September 17, 2002 10:54 AM To: Felker-Little, Susan Ce: Lynn, Debbie; Stivers, Lawrence Subject: FW: Florida Medical Center vs AHCA Susan, if you can settle this case for the amount set forth below, we will take it! If they don't agree, we will have to get a PRO review done ASAP for your trial preparation. KB From: Lynn, Debbie Sent: Tuesday, September 17, 2002 10:03 AM To: Bennett, Kelly Subject: Florida Medical Center vs AHCA Here are the figures for Florida Medical Center inhouse review completed by Donna Harrington. This provider had not previously submitted documentation so this was the first review. The original overpayment was $52,320.16, after the review, $46,340.48 owed, down by $5,979.68. Attached is the spread sheet that Susan Felker-Little will need. legalfloridaMed. xls Thanks, Nebhie Ban Human Services Program Specialist Medicaid Program Integrity (850) 413-9279 Fax: (850) 922-3806 E-mail: lynnd@fdhc.state.fl.us STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION FMC HOSPITAL, LTD. D/B/A FLORIDA MEDICAL CENTER Petitioner, v. DOAH CASE NO. 02-2908MPI AHCA Provider No. 010214800 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, (“AHCA” or “the Agency”), and FMC HOSPITAL, LTD. D/B/A FLORIDA 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 avoiding the costs and burdens of litigation. 2. PROVIDER is a Medicaid provider in the State of Florida, with provider number 010214800. 3. In its final agency audit report dated May 17, 2002, AHCA notified PROVIDER that a retrospective medical record review performed by The Florida Medical Quality Assurance, Inc. (FMQAI) and Medicaid Program Integrity (MPI) indicated that some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $52,320.16. In response to the final agency audit report, PROVIDER filed an amended petition for a formal administrative hearing. 4. The matter was referred to the Division of Administrative Hearings (DOAH) and assigned DOAH Case No. 02-2908MPI. Subsequently, PROVIDER submitted additional documentation to AHCA, and AHCA performed a review of the additional documentation related to the disputed claims and adjusted the overpayment to $46,340.48. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: {a) (b) (c) (@) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the FMQAI and MPI review. Within thirty (30) days of receipt of the Agency for Health Care Administration Final Order incorporating by reference this Settlement Agreement, PROVIDER agrees to make a single payment in the total sum of FORTY-SIX THOUSAND THREE HUNDRED FORTY AND FORTY-EIGHT CENTS ($46,340.48). The payment of $46,340.48 shall be made payable and remitted to: Agency for Health Care Administration Attn. Medicaid Accounts Receivable P. O. Box 13749 Tallahassee, FL 32317-3749 in full and complete settlement of all claims in the audit referenced as C.1. 01-0875-000, Payment shall clearly indicate that it is pursuant to a settlement agreement and shall reference C.I. 01-0875-000. 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. 01-0875- 000. (e) PROVIDER is responsible for ensuring timely delivery of the payment set forth herein. Furthermore, failure to timely make the payment will render the balance due and payable immediately, with statutory interest, and interest will continue to accrue until the entire balance is paid. AHCA reserves the right to seek enforcement of this agreement by any legal means. (f) 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. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shal! 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. 7. 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. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. The parties agree to bear their own attorney’s fees and costs, if any, except as hereinabove stated. 10. 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. 11. 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. 12. 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. 13. 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. 14. 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 ail 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 that is consistent with the terms of this settlement 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. 15. 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. 16. 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. 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. PROVIDER: FMC HOSPITAL, LTD. D/B/A FLORIDA MEDICAL CENTER _} al : Q 1h Dated ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 / , A un (foe Dated: / 7 , 2002. RUFUY NOBLE Inspector General Lith lbg— pateds_Lo 5, 2002 VALDA CLARK CHRISTIAN General Counsel SUSAN C. FELKER-LITTLE Assistant General Counsel

Docket for Case No: 02-002908MPI