STATE OF FLORIDA pe 7 AGENCY FOR HEALTH CARE ADMINISTRATION, FEB IFA Il: 48 SEG, INC. d/b/a SANDY’S DISCOUNT ch DRUGS, . 2 SAT co Petitioner, _ af. o - a bIip-clesed we ~ vs. CASE NO. 03-2115MPI “~~. PROVIDER NO. 101198700 ° STATE OF FLORIDA, AUDIT C.I. NO. 01-0211-000-3 AGENCY FOR HEALTH CARE Rendition No. AHCA-04- ‘15-S-MDO ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. 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 / z day of fli Lay , 2004, in Tallahassee, Florida. Geeaelegd fore _Shirda Pherae Ure onda M. TRS D, 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Andrew M. Dector, Esquire Shapiro, Blasi & Wasserman, P.A. Corporate Centre at Boca Raton 7777 Glades Road, Suite 110 Boca Raton, Florida 33434 (U.S. Mail) Errol Powell Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Claire Balbo: Medicaid imteeri John Hoover, Finance and Accounting rr i 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 “fubrouadd 2004. Lealand’McChafen, Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 qui et SA A ss STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS SEG, INC. d/b/a/ SANDY’S DISCOUNT DRUGS, Petitioner, vs. CASE NO. 03-2115MPI AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, (“AHCA” or “the Agency”), and SEG, INC. d/b/a SANDY’S DISCOUNT DRUGS (“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 avoiding the costs and burdens of litigation. 2. PROVIDER is a Medicaid provider in the State of Florida, with provider number 101198700. 3. In a final agency audit report dated April 7, 2003, AHCA notified PROVIDER that a 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 reimbursement in the amount of $14,576.97 (C.I. # 01-021 1-000-3/H/CAB). In response to the final agency audit report, on May 20, 2003, PROVIDER filed a petition for a formal administrative hearing contesting the overpayment. Sandy’s Discount Drugs D.O.A.H. Case No. 03-2115 MPL Settlement Agreement Page 2 of 6 4. The matter was referred to the Division of Administrative Hearings (DOAH) and assigned DOAH Case No. 03-2115MPL As a result of additional documentation submitted by the provider, the Overpayment figure was adjusted to $5,639.17. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA agrees to accept the payment methodology set forth herein in settlement of the Overpayment issues arising from the MPI teview. (b) Within thirty days of receipt of the final order, PROVIDER agrees to make a THREE THOUSAND TWO HUNDRED THIRTY-NINE DOLLARS AND SEVENTEEN CENTS ($3239.17) INITIAL PAYMENT. Every month thereafter, for six months, Provider agrees to repay the remaining Overpayment of TWO THOUSAND FOUR HUNDRED DOLLARS ($2,400.00), at a Statutory interest of 10%, to be paid in SIX (6) equal monthly payments of FOUR HUNDRED ELEVEN DOLLARS AND SEVENTY- FIVE CENTS ($411.75) each, (c) The six (6) consecutive monthly payments of $411.75 each shall be made payable and remitted to: Agency for Health Care Administration Attn. Medicaid Accounts Receivable P. O. Box 13749 Tallahassee, FL 3231 7-3749 in full and complete settlement of all claims in the formal hearing proceedings before AHCA concerning the audits referenced as Each payment Sandy’s Discount Drugs D.O.A.H. Case No. 03-2115 M.-P. Settlement Agreement Page 3 of 6 shall clearly indicate that it is pursuant to a settlement agreement, and each payment shall reference C.I. # 01-0211-000-3/H/CAB. (d) PROVIDER and AHCA agree 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 audits referenced as C.I. # 01- 0211-000-3/H/CAB. (ce) PROVIDER is responsible for ensuring timely delivery of the payments set forth herein. Furthermore, failure to timely make the payment will tender the balance due and payable immediately, with Statutory 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, (f) 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. 6. 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, _ 7. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 8. Parties agree to bear their own attorney’s fees and costs, if any, except as hereinabove stated. Sandy’s Discount Drugs D.O.A.H. Case No. 03-2115 M.P.I. Settlement Agreement Page 4 of 6 9. The signatories to this Agreement, acting in a Tepresentative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties, 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, ll. 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 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 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 that is consistent with the terms of this settlement 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. —— Ve NEN ecm nc Sandy’s Discount Drugs D.O.A.H. Case No. 03-2115 M.P.L Settlement Agreement Page 5 of 6 14. 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 patty originating or preparing it. 15. To the extent that any provision of this Agreement is prohibited by law, for any Teason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. 16. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 17. All times stated herein are of the essence of this Agreement. 18. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. PROVIDER: