FILED STATE OF FLORIDA - 93 DIVISION OF ADMINISTRATIVE HEARINGS . [NOV 1 8 OQ JORGE TRAVIESO, M.D., P.A., oo _ 3 Petitioner, vs. . AUDIT NO. CI 99-1507-000,.0, 2 STATE OF FLORIDA, AGENCY WZ OY FOR HEALTH CARE ADMINISTRATION, om RENDITION NO.: AHCA-03-¢ '/23-S-MDO 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 (3 day of Novernbex , 2003, in Tallahassee, Florida. fo Rhonda edows, MD, 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: Jorge Travieso Jorge Travieso Medical Center 2369 West 52™ Street Hialeah, FL 33016 Grant P. Dearborn, 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) Willie Bivins Finance & Accounting Medicaid Accounts Receivables Agency for Health Care Administration 2727 Mahan Drive, MS #14 (Interoffice) J.D. Parrish Administrative Law Judge DOAH (Interoffice) Ramon Rosario, Analyst MPI (Interoffice) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail on this the ]“¥__ day of 7 fener , 2003. dU, pata Lealang’McCharén, Esquire Laphere Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 SEP-26-2003 14:18 P.@2 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS JORGE TRAVIESO, M.D., P.A., Petitioner, CASE NO. 03-2956MPI vs. AUDIT NO. C] 99-1507-000 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA’ or “the Agency”), and Jorge Travieso, M.D., P.A. (‘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 . resolving the subject litigation. 2. PROVIDER is a Medicaid provider in the State of Florida, 3. In its final agency audit report dated April 27, 2002, 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 $13,988.23. In response to the audit letter dated April 27, 2002, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 03-2956MPI. 4. in order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: SEP-26-2883 6. 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 14:18 (1) (2) (3) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of the Agency's issuance of the final order, PROVIDER agrees to make a single payment of thirteen thousand nine hundred eighty-eight dollars and twenty-three cents ($13,988.23) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 03-2956MP)). 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 audit referenced as C.1. 99-1507-000-RNR. 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. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 PROVIDER agrees that failure to pay any monies due and owing under 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 * SEP-26-2803 14:18 P.64 State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. Each party shall bear its own attorneys’ fees and costs, if any, except as set forth herein. 10. 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, 11. | 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, 12. 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. 13. 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 “OCT-27-2883 89:40 AGENCY HEALTH CARE ADMIN 856 921 9158 P.@5 as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 14. 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 which is consistent with the terms of this settlement agreement 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. 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. OCT-27-2883 99:48 AGENCY HEALTH CARE ADMIN 858 921 6158 P.Q6 20. The provider agrees to cooperate in and consent to comprehensive follow- up reviews of the provider every 6 months to ensure that they are billing Medicaid correctly. JORGE TRAVIESO, M.D., P.A. “1 Fale A , 4 Jl Z!2. (Provider's name) Jorge Travieso, M.D., P.A. Dated: [¢[ 2 , 2003 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: Vovemmbea 19 , 2003 Judith Hefren Acting/Inspector General Mk ve Dated: OcT. 14 , 2003 Grant P. Dearborn Assistant General Counsel a pw XK oun Dated: 0/2 , 2003 Kim Kellum Chief Medicaid Counsel 4, Y, J Al , 4, (de MAE Date: He , 2003 Valda Clark Christian General Counsel

Docket for Case No: 03-002956MPI