STATE OF FLORIDA eet OP AGENCY FOR HEALTH CARE ADMINISTRATION a S00 chred BAPTIST HOSPITAL OF MIAMI, Petitioner, DOAH CASE NO. 02-4297MPI _ vs. CASE NO. 01-209PH ae) RENDITION NO.: AHCA-02- “~S-MDP. STATE OF FLORIDA, a AGENCY FOR HEALTH CARE : ADMINISTRATION, - “=n Respondent. / : i FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on _November 26 , 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 ZG day of portenhn— 2002, fot MD, Secretary Agency for Health Care Administration in 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: Garnett Chisenhall Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Steven T. Mindlin, Esquire Rose, Sundstrom & Bentley, LLP 2548 Blairstone Pines Drive Tallahassee, FL 32301 (U.S. Mail) Florence Rivas Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Judy Hefren, Deputy Inspector General Sue Gibson, 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 ce day of | Yrenhee , 2002. Chavere Vows Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION BAPTIST HOSPITAL OF MIAMI, ) ) Petitioner, ) ) vs. ) AHCA Case No. 01-209PH ) AHCA Provider No. 010035800 STATE OF FLORIDA, AGENCY FOR ) HEALTH CARE ADMINISTRATION, ) ) Respondent. ) ) SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and BAPTIST HOSPITAL OF MIAMI (“Provider”) by and through the undersigned, hereby stipulate and agree as follows: 1. PROVIDER is a Medicaid provider in the State of Florida.. 2. In its Final Agency Audit Report issued on October 9, 2001 (the “Audit Letter”) AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $91,216.07. 3. In response to the Audit Letter, PROVIDER filed a petition for an informal administrative hearing that was assigned Case No. 01-209PH. 4. The informal hearing officer determined that issues of fact existed and that the matter was inappropriate for adjudication by an informal hearing. As a result, the matter was referred to the Agency Clerk for referral to the Division of Administrative Hearings. R E Cc FE | V E D GENERAL COUNSEL NOV 07 2002 Agency for Heaith Care Administration 5. Subsequent to the audit that took place in this matter and in preparation for trial, AHCA re-reviewed the PROVIDER’S claims. As a result, AHCA determined that it would be willing to settle the dispute regarding the results of its audit if PROVIDER agreed to pay AHCA $76,746.37. PROVIDER has, for the reasons set forth herein, agreed to pay $76,746.37 as full and complete resolution of this matter. Of that amount, $1,000 will be allocated by AHCA to AHCA’s investigation costs. 6. In order to resolve this matter without further administrative proceedings, and in an attempt to avoid the costs and uncertainty of litigation, PROVIDER and AHCA expressly agree as follows: (a) (b) (c) (d) AHCA agrees to accept the payment set forth herein in full settlement of the alleged overpayment issues arising from the MPI review, PROVIDER agrees to pay AHCA, within 30 days after issuance of a Final Order, the sum of $76,746.37 to be made in one lump sum payment as full and complete settlement of all claims in the proceedings before the Agency and the Division of Administrative Hearings (AHCA Case No. 01-209PH). PROVIDER is responsible for ensuring timely delivery of the payment. Furthermore, failure to timely make the payment will render the balance due and payable immediately, with interest, and said 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. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all 2 (f) (g) (h) (i) liabilities arising from the findings in the audit referenced as C.I. No. 01- 0651-000. AHCA agrees that it will not seek or impose any sanctions against PROVIDER arising out of the issues presented in this matter, provided that PROVIDER timely makes the complete payment to AHCA called for by this Agreement. 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. PROVIDER agrees that failure to make payment as per the terms of this Agreement may result in the Agency pursuing all legal means to enforce this Agreement. PROVIDER also agrees that failure to make payment as per the terms of this Agreement may result in the Agency intercepting its Medicaid payments until the balance due is repaid. PROVIDER also agrees that failure to make payment per the terms of this Agreement may result in sanctions, which may include termination from the Medicaid program. 7. Payment shall be made payable to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 The payment shall clearly indicate that it is per a settlement, shall reference the Case Number, and shall reference the C.I. Number, 8. 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, 3 to withhoid the total remaining amount due under the terms of this Agreement from any monies due and owing to PROVIDER for any Medicaid claims. 9. 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. 10. The parties each agree to bear their own attorney’s fees and costs, if any, except as expressly set forth in this Agreement. 11. The signatories to this Agreement, acting ina representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. The parties further agree that a facsimile or photocopy reproduction of this Agreement with PROVIDER’S authorized signature shall be sufficient for the Agency to enforce the Agreement and to cancel the hearing in this matter. Furthermore, PROVIDER agrees that upon receipt of the monies due and owing under this Agreement, and upon PROVIDER’S signature on this Agreement, AHCA shall file the appropriate documents or pleadings necessary to cancel the hearing in this matter. 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 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 of this Agreement 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, other, 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. PROVIDER voluntarily enters into this Agreement in an attempt to resolve all outstanding issues discussed herein, but in so doing makes no admission of any wrongdoing regarding the matters at issue. 15. PROVIDER expressly waives its right to any hearing in this matter 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 the Agency should issue a Final Order which is consistent with the terms of this settlement, that adopts this Agreement and closes this matter. 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. BAPTIST HOSPITAL OF MIAMI Petitioner/Provider wd “4, fa le, AMF h gf tem Dated: Liemper oe , 2002 Jody Lehmari; Esquire ‘ - General Counsel Baptist Health Systems of South Florida 6855 Red Road, Suite 600 Coral Gables, Florida 33143 (305) 661-0363 SS fou, ? VEYA Dated: Aenbey ? , 2002 Steven T. Mindlin, P.A. Fla. Bar #378534 John L. Wharton, Esq. Fla. Bar #563099 Rose, Sundstrom & Bentley, LLP 2548 Blairstone Pines Drive Tallahassee, Florida 32301 (850) 877-6555 Attorneys for Provider AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Ape Dated: “fe , 2002 Rufus Néble Inspector General pall Di Valda Clark Christian, Esquire General Counsel SF arnwett C bras, toll Dated: Ui ltrle 2 , 2002 Garnett Chisenhall, Esquire Assistant General Counsel Dated: MO BR. , 2002 baptist/miami/settlement.agr i STATE OF FLORIDA @ ~IAHCA ——_————— SK AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RHONDA M. MEDOWS, MD, FAAFP, SECRETARY October 9, 2001 CERTIFIED MAIL — 7001 0360 0003 1559 9616 ER EAE = L004 0360 0003 1559 9616 Provider No. 010035800 Ms. Jane Dohre Director, Case Coordinator TW Baptist Hospital of Miami R E C E I V E D 8900 North Kendall Dr. Miami, FL, 33176 NOV 06 2001 MEDICAID PROGRAM RE: FINAL AGENCY AUDIT REPORT INTEGRITY C.1. 01-0651-000 Dear Ms. Dohre: Please refer to our provisional agency audit report dated April 23, 2001, wherein we made a preliminary determination that you were overpaid $205,960.56, for services not covered by Medicaid. This was based on retrospective medical record review by the Florida Medical Quality Assurance, Inc. (FMQAI), 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 $91,216.07 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 miles 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.state fl.us ’ L ol Kee 2727 Mahan Drive » Mail Stop # Tallahassee, FL 32308 1" 10° : ee nee Baptist Hospital of Miami page2° Pursuant to Florida Administrative Code 59G-4.150 (06/09/96) and Florida Medicaid Hospital Coverage and Limitations, January 1999, Appendix J, under Notice of Adverse Determination, request for reconsideration of an initial adverse determination was to be made in writing to the PRO within sixty calendar days after receipt of the denial notice. Of the attached (see attachment) 28 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 26 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 2 claim(s), you have the right to request a formal or informal hearing pursuant to section 120.569, ES. 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. 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. If you concur with the amount of the Overpayment, send your check for $91,216.07. 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 . c Tallahecsee Herida 32317-3749 RECEIVED NOV 06 2001 MEDICAID PROG ‘AM INTEGRITY nee —_—_——— Baptist Hospital of Miami page3 ° Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts receivable, (850) 487-4298. Y have about this matter should be directed to: 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 Program Administrator MVM:sbg Enclosures ce: Medicaid Program Development Area Medicaid Office Willie Bivens Medicaid Accounts Receivables RECEIVED NOV 06 200) MEDICaln PROG cam INT.G Wry

Docket for Case No: 02-004297MPI