~ FILED STATE OF FLORIDA AGENCY FOR AGENCY FOR HEALTH CARE ADMINISTRI@SOIN CARE ADMINISTRATION DEPUTY CLERK MBC MEDICAL CENTER, INC., CLERK Petitioner, “The ppmecjauf Sod vs. CASE NO. 03-2394MPI AUDIT NO. CI 01-0943-000 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER This cause came before me for issuance of a Final Order. In a Final Agency Audit Report dated May 29, 2003 (audit number C.I. 01-0943-000). Petitioner, MBC Medical Center, Inc. was informed the Agency was seeking to recover Medicaid overpayments of $122,924.07. The letter was sent certified mail, return receipt requested to MBC Medical Center (hereinafter “PROVIDER”), who received said document. The letter contained full disclosure and notice regarding the PROVIDER’S administrative hearing and due process rights. The PROVIDER filed a petition for hearing. The PROVIDER withdrew the petition. Jurisdiction was relinquished by the Division of Administrative Hearings to the Agency for Health Care Administration. FINDINGS OF FACTS The PROVIDER received the Final Agency Audit Report and that report disclosed to the providers his administrative and due process rights. The PROVIDER filed a petition and later withdrew the petition. Therefore, petitioner has chosen not to dispute the facts set forth in the Final Agency Audit Report dated May 29, 2003. Therefore, those facts are hereby deemed admitted, additionally the total overpayment amount of $122,924.07 is deemed admitted, and these facts form the factual basis for the existence of an overpayment owed by the PROVIDER, in the amount of $122,924.07. The facts set forth in the Final Agency Report are hereby adopted. That amount is now due and owing, with interest, since the date of May 29, 2003. CONCLUSIONS OF LAW The Agency incorporates and adopts the statements and conclusions of law as set forth in the Final Agency Audit Report dated May 29, 2003. The admitted facts and facts support the conclusion that the overpayment is due and owing, under the law generally set forth in the final audit letter. Under Florida Statute 409, interest accrues on this overpayment from May 29, 2003. Based on the foregoing, it is ORDERED AND ADJUDGED that Petitioner refund, forthwith, the sum of $122,924.07, together with statutory interest as set forth in Section 409.913, Florida Statutes, from the date of May 29, 2003. DONE AND ORDERED this ge day of ##Y ___, 2004, in Tallahassee, Florida. Gand Pad. fe charm Scretary Peary Mat Mame 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: Wilson, Suarez, and Lopez ATTN: Mike Gennett, Esquire Mezzanine Floor 2151 LeJeune Road Coral Gables, Florida 33134 J.D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Debora Fridie, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice) Timothy Byrnes, Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, MS #5 Tallahassee, Florida 32308 (Interoffice) Finance & Accounting Medicaid Accounts Receivables Agency for Health Care Administration (Interoffice) Adolfp’Garcia, Analyst CERTIFICATE OF SERVICE THEREBY 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 TY arf , 2004. ye Lealand QF Esquire © Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 Received Event (Event Succeeded) “Dates——_«t020103. ee oe Date: 10/20/03 Time: 7:59 AM Pages: 2 Sender: 3054467336 _Remote £51957 208954967336 — sosaae7aa6 WILSON SUAREZ LOPEZ PAGE a2 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION MBC MEDICAL CENTER, INC., Petitioner, CASE NO. 03-2394MPI TP P C.I. NO. 01-0943-000 v. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. t NOTICE OF DISMISSAL FOR AD} EA G Petitioner, MBC Medical Center, Inc., (“MBC”), by and through undersigned counsel and pursuant to the applicable mules of Procedure, hereby gives notice of the dismissal and withdrawal of its petition for formal administrative hearing in this matter. CERTIFICATE OF SERVICE Z 1K I HEREBY CERTIFY that a true and correct copy of the foregoing was this Dia of October, 2003 mailed and faxed to Ms Deborah E. Fridie, Assistant Generat Counse}, Agency for Health Care Administration, 2727 Mahan Drive, Mai) Stop #3, Tallahassee, Florida, 32308. ilson Suarez & Lopez 151 Le Jeune Road, Mezzanine Floor Florida Bar No. 0097871

Docket for Case No: 03-002394MPI