CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 0217 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO: 2002047851 VS. . Pp a p>ogay THE HEALTH CENTER OF DAYTONA BEACH, INC. RECEIVED JAN 8 2003 d/b/a THE HEALTH CENTER OF DAYTONA BEACH Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint, against The Health Center of Daytona Beach, Inc. d/b/a The Health Center of Daytona Beach (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1) This is an action to impose an administrative fine in the amount of TWELVE THOUSAND DOLLARS ($12,000) pursuant to §§ 408.034 and 408.040 Florida Statutes. 2) The Respondent was cited for failure to comply with conditions upon its Certificate of Need (CON) set forth below for the calendar year 2001. JURISDICTION AND VENUE 3) AHCA has jurisdiction over the Respondent pursuant to §§ 408.031-408.45, Florida Statutes, the “Health Facility and Services Development Act.” 4) Venue lies in Leon County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28-106.207 Fla. Admin. Code. Page | of S 5) 6) CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 0217 PARTIES AHCA is the enforcing authority with regard to the issuance, revocation, or denial of certificates of need or the exemptions of certificates of need pursuant to §§ 408.031-408.45, Florida Statutes, the “Health Facility and Services Development Act,” Chapter 400, Part II, Florida Statutes and Rules 59C-1, Florida Administrative Code. Respondent is a COMMUNITY NURSING HOME located at 550 National Healthcare Drive, Daytona Beach, FL 32114. The Respondent is licensee effective October 1, 2000 on the Certificate of Need issued on June 29, 2000 for the 60-bed community nursing home with the condition that 54 percent of the total annual patient days for the 60-bed facility shall be allocated to Medicaid patients. The certificate number is CON #7299 and a copy is attached to this complaint as Exhibit “A”. The original CON was issued on April 9, 1993 and the June 2000 date reflects the date the CON condition was reduced, COUNT I RESPONDENT FAILED TO MEET THE CONDITION THAT 54 PERCENT OF THE TOTAL ANNUAL PATIENT DAYS FOR THE 60-BED FACILITY SHALL BE ALLOCATED TO MEDICAID PATIENTS. FLA. ADMIN. CODE R. 59C-1.013, 59C-1.021, §§ 408.034(5), 408.040, 7) 8) 9) FLA. STAT. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. The Respondent operates The Health Center of Daytona Beach, a 60-bed community nursing home authorized by Certificate of Need Number 7299. Pursuant to § 408.040(1)(a), F.S., CON #7299 contains the following condition: a minimum of 54 percent of the total annual patient days for the 60- bed facility shall be allocated to Medicaid patients. As required by Florida Administrative Code Rule 59C-1.013(4), the Respondent filed an annual compliance report indicating that the facility did not comply with the Medicaid condition for calendar year 2001. Exhibit “B” attached is a copy of the annual compliance report. Additionally, the Florida Page 2 of 5 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 0217 Nursing Home Utilization by District and Subdistrict January 2001-December 2001 data indicates that the facility did not comply with the Medicaid condition. Exhibit “C” attached is a copy of the Florida Nursing Home Utilization by District and Subdistrict January 2001-December 2001 data, page 73. Findings include: a) The Florida Nursing Home Utilization by District and Subdistrict January 2001-December 2001 data indicated that the facility provided 36.05 percent of the total annual patient days for the 60 bed facility to Medicaid patients and the facility report indicated that the facility provided 36.94 percent of the total annual patient days in the 60 bed facility to Medicaid patients. 10) Based upon the forgoing, the Respondent was in noncompliance with the condition(s) set forth in its Certificate of Need. 11) The above referenced violation constitutes the grounds for which a fine of Twelve Thousand Dollars ($12,000) is authorized under Fla. Admin. Code R. 59C-1.013, 59C-1.021, and §§ 408.034(5), 408.040 Fla. Stat. CLAIM FOR RELIEF FOR COUNT I 12) WHEREFORE, AHCA requests this Court to order the following relief; a) Make factual and legal findings in favor of AHCA on Count I, b) Impose a fine of Twelve Thousand Dollars ($12,000) for the noncompliance cited in Count I against the Respondent under Fla. Admin. Code R. 59C-1.013, 59C-1.021, and §§ 408.034(5), 408.040 Fla. Stat. NOTICE The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be Page 3 of 5 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 0217 made to the attention of Joanna Daniels, Assistant General Counsel, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, FL 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, joamppeee Assistant General Counsel FL Bar #0118321 Agency for Health Care Administration 2727 Mahan Dr., MS #3, Tallahassee, FL 32308 (850) 922-5873 Fax (850) 413-9313 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy hereof has been furnished to Administrator, Daytona Healthcare Center of Daytona Beach, 550 National Healthcare Drive, Daytona Beach, FL 32114. Receipt No. 7106 4575 1294 2050 0217 by U.S. Certified Mail, on January 3, 2003. ’ Copies furnished to: Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 (Interoffice Mail) Karen Rivera AHCA/CON Office 2727 Mahan Drive MS 28 Tallahassee, FL 32308 (Interoffice Mail) JD/ghm Suane Bene Joanna Daniels Assistant General Counsel Joanna Daniels Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 Page 4 of 5 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMIN) ISTRATION CERTIFICATE OF NEED Under the provisions of the “Health Facility and Services Development Act” (Sections 408.031-.045, Florida Statutes (Supp 1992), AND Chapter 59C-1, Florida Administrative Code), the Agency for Health Care Administration certifies the need for this project. ****Modification (6/29/00) ***Final Order dated 2/3/99 **Cost overrun via CON #8574 Transfer via CON #7298 *Modification NUMBER: 7299 APPLICANT; National HealthCorp, L.P. PROJECT COST: ***$6,297,154 100 Vine Street ISSUE DATE: April 9, 1993 Murfreesboro, Tennessee 37130 TERMINATION DATE: April 8, 1994 REVISED TERMINATION DATE: July 19, 1994 COUNTY: — Volusia DISTRICT: 4 SUBDISTRICT: 4 PROJECT DESCRIPTION: Construct a 60 bed community nursing home involving *41,529 GSF of new construction and consisting of $1,705,400 in construction costs. patients. FORM 1793, APRIL 1993

Docket for Case No: 03-000934