STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION A K lt GT 12 A i 34 HENDERSON MENTAL HEALTH CENTER, INC., a4 ipa C Petitioner, — Q a Py . GO vs. DOAH No. 03-1192 a JUDGE: Errol H. Powell 9 7 > AGENCY FOR HEALTH CARE C.I. 02-0240-013° ADMINISTRATION, “KRerd chon 18. AHCA-04-BI4~ MEO ro 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 30" day of se“7ang7e 2004, in Leon jo Een Levine, Secrétary Agency for Health Care Administration County, 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: James M. Barclay, Esquire Attorney for Petitioner Ruden McCloskey 215 South Monroe Street, Suite #815 Tallahassee, FL 32301 Errol H. Powell, Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Anthony L. Conticello, Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Tom Amold, Deputy Secretary for Medicaid Agency for Health Care Administration (Interoffice Mail) Lawrence Stivers, Medicaid Program Integrity Agency for Health Care Administration (Interoffice Mail) Jean Lombardi, Office of Finance & Accounting Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was served to the above named addresses by U.S. Mail or method designated this / Z day of , 2004. AgencyClerk ‘Agency for Health Care Adrhinistrati 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMISTRATION HENDERSON MENTAL HEALTH CENTER, INC., Petitioner, CASE NO: 03-1192 v. JUDGE: Errol H. Powell STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and HENDERSON MENTAL HEALTH CENTER, INC. (“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 memorializing the resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, having the Medicaid Provider No. 060338411. 3. In its Final Agency Audit Report issued on January 28, 2003, bearing C.I. No. 02- 0240-013 (the "Audit Letter"), AHCA notified PROVIDER that review of paid Medicaid claims 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 $5,828.75. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing that was assigned DOAH Case No. 03-1192MPI, and sent in additional TAL:47353:1 documentation for AHCA to review. Based upon the additional documentation, AHCA adjusted the overpayment to $3,015.00. PROVIDER agrees to pay the entire adjusted overpayment amount. 4, In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA agrees to accept the payment set forth herein in settlement of the Overpayment issues arising from the MPI review. (b) PROVIDER agrees to pay to AHCA the entire Adjusted Overpayment amount of $3,015.00 in one lump sum, as complete settlement of all claims in the proceeding before the Division of Administrative Hearings and the Agency. The lump sum payment is due one month after the entry of the Final Order. (c) 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 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. (d) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all liabilities arising from the findings in the audit referenced as: CL No. 02- 0240-013. TAL:47353:1 2 (e) 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. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement, shall reference both the Provider Numbers, and the C.1. Number. 6. 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. 7. AHCA reserves the tight 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. The parties agree to bear their own attorney’s fees and costs, if any. 9. 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. Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Settlement Agreement to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel a final hearing, if one is pending, and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. TAL:47353:1 3 10. 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. 11. This Agreement constitutes the entire agreement between PROVIDER and the 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 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. 12. 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. 13. 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 tules 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. 14, Provider, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter, C.I. No. 02-0240-013, AHCA’s TAL:47353:1 4 actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Facility. 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. TAL:47353:1 5 PETITIONER: HENDERSON MENTAL HEALTH CENTER, INC. Datedisur 7) , 2004. Dated: he [ 0 , 2004, PLACE CORPORATE SEAL ABOVE STEVEN RONIK, Ed.D. BY: Chief Executive Officer ITS: Attorney for Petitioner AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 ee Pbad Dated: 7- Fo Oe , 2004. JAMES D. BOY Inspector General Liste adel Dated: ih Z , 2004, VALDA CLARK CHRI General Coufisel (HS C Dated: Hye + & 2004. ANTHONY L. CONTICELLO Assistant General Counsel TAL:47353:1 6

Docket for Case No: 03-001192MPI