STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS ELOMAR DRUG CORPORATION, d/b/a fue eons CARDENAS PHARMACY, Poa, Petitioner, CASE NO: 03-1976MPI C.I. No. 01-1478-000-3 JUDGE: John G. Van Laningham STATE OF FLORIDA, AGENCY FOR Medicaid Provider No.: 1033417-00 HEALTH CARE ADMINISTRATION, v. Respondent. FINAL ORDER 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. 7 DONE and ORDERED on this the <2> day of PIAL , 2005, in Tallahassee, Florida. fr-A¥an Levine, Secretary 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: Ernesto Cespedes Attorney for Petitioner 12080 SW 127" Ave, #144 Miami, FL 33186 John G. Van Laningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399 Anthony L. Conticello, Esquire Agency for Health Care Administration (Interoffice Mail) James D. Boyd, Inspector General Agency for Health Care Administration (Interoffice Mail) Timothy Byrnes, Bureau Chief Medicaid Program Integrity Agency for Health Care Administration (Interoffice Mail) Bureau of Finance and Accounting Agency for Health Care Administration (Interoffice Mail) 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 a aay of ASE , 2005. - a Richard Shoop, Agency Cler’ Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA PM ne go, DIVISION OF ADMINISTRATIVE HEARINGS : Fe ELOMAR DRUG CORPORATION, d/b/a . CARDENAS PHARMACY, fe . Petitioner, CASE NO: 04-1079MPI Vv. JUDGE: John G. Van Laningham STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (SAHCA” or “the Agency”), and Elomar Drug Corporation d/b/a Cardenas Pharmacy (“PROVIDER”). by and through the undersigned. hereby stipulate and apree as follows: I. This Agreement is entered into between the parties for the purpose ot memorializing the resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, and has been issied the following Medicaid Provider Number: 1033417-00. 3. in its Final Agency Audii Report issued on April 7, 7093 (the “Audit borter™ 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 S41.661.47 tthe “Overpayrnaent Amount”). In response to the Audit Letter, PROVIDER disputed the Agency’s findings and filed a petition for a formal administrative hearing that was assigned DOAH Case No, 94- 1079MPI (formerly 03-1976MPI). 4. In order to resolve this matter without further administrative proceedings. PROVIDER and AHCA expressly agree as follows: (a) (b) (c) (d) (e) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. PROVIDER, as complete settlement of all claims in the proceedings before the Division of Administrative Hearings, agrees to pay to AHCA $42.661.47, broken down as follows: the Overpayment Amount of $41,661.47; plus an additional 1.600 in attorneys tees and cosis reimbursable to AHCA. Provider agrees to pay this amount in one lump sum, which shall be due at AHCA thirty (30) days after the entry of the Final Order. 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 seck 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 all parties from all liabilities arising from the findings in the audit referenced as: C1. No. 01- 1478-000-3. 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. bo a) 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 the DOAH Case Number (No. 04-1079MPI. formerly 03-1976MP]). and shall reference the C.I. Number (C.1. No. 01-1478-000-3). 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 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. 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. Furthermorc, PROVIDER agrees that its signature alone binds PROVIDER to make the parmen! 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 the final hearing and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. 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. ae 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 lacts 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 and AHCA expressly waive. in this matter, their 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 they may be entitled by Jaw or rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER and the Agency further agree 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 attorneys 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 specifically related to this matter - DOAH Case No. 64- 1079MPI (formerly 03-1976MPI), C.1. No. No. 01-1478-000-3. and AHCA’s actions herein. including, but not limited to. any claims that were or may be asserted in any federal or state cout or administrative forum, including any claims arising out of this agreement. by or on behalf of Facility. The Agency for Health Care Administration. does hereby discharge PROVIDER. and its agents, representatives, and attorneys 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 specifically related to this matter - DOAH Case No. 04-1079MPI (formerly 03- 1976MPI), C.1. No. 01-1478-000-3, and PROVIDER’s 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 the Agency. with the specific exception that the Agency’s discharge does not include any future actions by the Provider that relate to Medicaid Fraud. Notwithstanding the foregoing, nothing herein prohibits the Agency from pursuing an action to enforce the settlement agreement or final order. 18. This Agreement is and shall be deemed jointly drafted and written by all parties te 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. nN PETITIONER: ELOMAR DRUG CORPORATION, d/b/a CARDENAS PHARMACY, WS A_- ated: Peer 2 2004, Dated: CocXdo ev DO. 2004. Attorney(for Petitipner 12080 S Ave, #144 Miami. FL 33186 PLACE CORPORATE SEAL ABOVE AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Space DOGy | Dated: SAS , 2005. JAMES D. BOYD oP Inspector General 4 LO _ J LAE — 5 fe ; j LL Ker Dated: BLY , 2005. WILLIAM ROBERTS Acting Gener’) Counsel / ~ (2 (< Spel J — — Dated: yy rl od , 2005. ANTHONY L. CONTICELLO Assistant General Counsel

Docket for Case No: 03-001976MPI