STATE OF FLORIDA SER DIVISION OF ADMINISTRATIVE HEARINGS ESPIMAR CORPORATION d/b/a MARQUEZ PHARMACY, Petitioner, 4 SM) - Clos vs. CASE NO. 02-4414MPI ASO “Pendithan NO AGA (DAA SMBC STATE OF FLORIDA, ; 2 AGENCY FOR HEALTH CARE oO ADMINISTRATION, me "9 vo ww Respondent. = - —_ / ne ra oD FINAL ORDER a ‘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 attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the 4 day of Chexeok __, 2003, in Tallahassee, Florida. kn Rhond Al) Med s, MD, Secretary Agency 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Juan C. Bermudez, Esquire Bermudez & Tome 8300 N.W. 53 Street, Suite 300 Miami, Florida 33166 (U.S. Mail) Stuart Lerner Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Kathryn Holland, Medicaid Program Integrity John Hoover, 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 | | day of fi Ue LOE, 2003. Chante Uheudsen -PRLealand McCharen, Esquir® 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 DIVISION OF ADMINISTRATIVE HEARINGS ESPIMAR CORPORATION d/b/a MARQUEZ PHARMACY, Petitioner, vs. CASE NO. 02-4414MPI STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Espimar Corporation d/b/a Marquez Pharmacy (“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 103116300 and was a provider during the audit period. 3. In its final agency audit report (final agency action) dated October 12, 1998, 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 $124,823.88. In response to the audit letter dated October 12, 1998, PROVIDER filed operas Up ier emer Hage 6 tee ie Settlement Agreement a petition for an informal administrative hearing, which was assigned AHCA Case No. 01- 199PH. It was later determined that their were facts in dispute so the matter was referred to the Division of Administrative Hearings and assigned DOAH case number 02-4414MFI. 4. As the pre-trial phase of the case took place, the Agency became aware. of additional facts and circumstances conceming the drug inventory issues. As a result, AHCA agreed to resolve this matter for a total repayment of $92,370.00, as set forth below. 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 MP] review. (2) Within thirty days of receipt of the final order, PROVIDER agrees to make the first installment to repay ninety thousand dollars ($90,000.00) in overpayment and two thousand three hundred seventy dollars ($2,370.00) in investigative costs for a total payment of ninety two thousand three hundred seventy dollars ($92,370.00) plus 10% interest per year to be made in three (3) monthly payments in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 02-4414MPI). AHCA retains the right to perform a 6- month follow-up review. ‘a LLOpern cnet Nene peeee aE emer rerene perenne sem roe Settlement Agreement (3) PROVIDER and AHCA agrec 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 CI. 97-0391- 000-3. (4) PROVIDER agrees that it will not rebiJ] 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 applicabje 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. 11. 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. Seitlement Agreement 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, including anyone acting for, associated with or employed by them, concerming all matters and supersedes any prior discussions, agreements or 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 wnitten 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. 15. | 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. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlernent 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. 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. ween meee ree qa tte ne Settlement Agreement 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. 19. All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in ful) force and effect upon execution by the respective parties in counterpart. ESPIM. CORPORATION d/b/a MARQUEZ PHARMACY Dated: Apel 1*7 2003 __ Print name) ITS: PResv ston fo AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 —_—_ Gite Dated: agate od , 2003 RufusNobie Sua + . He Inspector General Dated: fo Af 2003 Dated: j Le- » 2003 Assistant General Counse STATE O@ RIDA AGENCY FOR HEALTH CARE ADMINISTRATION ~ October 12, 1998 VIA._ CERTIFIED U.S. MAIL iE JEG EDS RETURN RECEIPT REQUESTED | EEE 7 IT Espimar Corporation - d/b/a Marquez Pharmacy. ° 5901 W. 16" Avenue ..- - — Hialeah, Florida 33012 Wl RINNE gaa yaee Aa fie ACEOUNTING Lt Re: Agency Audit C.I. No. 97-0391-000-3 Provider No. 1031163-00 Dear Provider: oe nia oe -The--Office of Medicaid Program Integrity (“MPI”) has completed its review of claims submitted under your Medicaid Provider number 1031163-00 for the time period beginning July 14, 1995, through and including January 9, 1997. This audit found chat Medicaid overpaid you in the amount of $124,823.88. This audit revealed that certain services billed under your provider number could not have been provided with your inventory and purchases of pharmaceuticals. Given these findings, this agency is compelled to seek a resolution of this matter. In an effort to expedite and simplify this process, we will extend to you the opportunity to settle this matter: Any settlement at this juncture will save both you and this office the burden and expense of litigation, as well as minimize the public airing with regard to any improper claims. The final terms of any settlement will be incorporated into a written agreement, and will effectively bring this matter to a close. Please be advised however, that in resolving situations involving false Medicaid claims, this agency may seek interest, investigative costs, or penalties as part of any negotiated settlement. Finally, please be advised that should we be unable to settle this matter, this office will consider proceeding under the Florida False Claims Act (section 68.081, Florida Statutes, er seq.) Successful prosecution of such a case for any false claims sudmitted on or after July 1, 1994, would result in full restitution of the moneys in question plus the award of treble damages (triple the amount paid) together with a mandatory minimum $5,000 penalty per false claim - the maximum penalty per false claim is $10,000. If an agreement is reached between the appropriate parties, however, this agency would forego filing an action. OFFICE OF THE GENERAL COUNSEL Fort Knox Building 3. *« 2727 Mahan Drive TALLAHASSEE. FLORIDA 32308-5403 LAWTON CHILES, GOVERNOR Should you wish to discuss settlement of this matter, please call me at (850) 922-5873 by October 30, 1998. If I do not hear from you, I will assume that you are not interested in discussing this matter and will pursue any and all remedies available. Yours Truly, LEE. - Costas Miskis Assistant General Counsel Office of the General Counsel (VIA U.S. MAIL RETURN RECEIPT REQUESTED) Rosa Marquez 1030 W. 53” Street, Hialeah, FL Elio Marquez 1030 W. 53 Street, Hialeah, FL David Marquez 1030 W. 53™ Street, Hialeah, FL Elio L. Marquez ; 850 W. 53 Street Hialeah, FL cc: . bee: Edward Turner, Chief, Medicaid Program Integrity Elinor Schroeder, Medicaid Accounts Receivable Kathryn Holland, Medicaid Program Integrity

Docket for Case No: 02-004414MPI