STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION THERAPEUTIC WHEELCHAIR SPECIALISTS, INC., Petitioner, vs. AHGA No. 2004002891 ~ DOAH No. 04-1884 . 2 AGENCY FOR HEALTH CARE =LB oS ADMINISTRATION RENDITION NO.: AHCA-04- O4063-S-BLC Gi (ut Respondent. | FINAL ORDER The Agency for Health Care Administration, having entered into a Joint Stipulation and Settlement Agreement, and being otherwise fully advised in the premises, determines as follows: The attached Joint Stipulation and Settlement Agreement is approved and adopted as a part of this Final Order and the parties are directed to comply with terms of the Joint Stipulation and Settlement Agreement. THEREFORE, it is ORDERED and ADJUDGED: 1. That the parties hereto are directed to comply with the terms of the Joint Stipulation and Settlement Agreement. 2. A fine of TWO HUNDRED FIFTY AND 00/100 DOLLARS ($250.00) is hereby imposed upon THERAPEUTIC WHEELCHAIR SPECIALISTS, INC. The fine is due and payable within (30) days of the date of rendition of this Order. AHCA No. 2004002891 Page 1 of 3 Final Order 3. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to this case number, should be sent directly to: Jean Lombardi, Office of Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308. 4. Unpaid fines will be subject to statutory interest, and may be collected by all methods legally available. DONE and ORDERED this //_ day of Lagestt , 2004, in Tallahassee, Leon County, Florida. ~ Z Agency foy/Health Care a on A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH AGENCY CLERK AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, IN THE DISTRICT COURT OF APPEAL WHERE THE AGENCY MAINTAINS ITS HEADQUARTES 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 THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: James P. Marsh, President Therapeutic Wheelchair Specialists, Inc. 5920 Palmer Boulevard Sarasota, FL 34232 Fred L. Buckine, Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 AHCA No. 2004002891 Page 2 of 3 Final Order Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration (Interoffice Mail) Joanna Daniels, Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Jean Lombardi, Office of Finance & Accounting Agency for Health Care Administration (Interoffice Mail) Wendy Adams, Regulatory Consultant Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing was delivered by U.S. Mail or other method designated to the persons listed above on this/lo. day of A UG AQT, 2004. ltr Agency for Health Care adinitration 2727 Mahan Drive, Building #3, MS #3 Tallahassee, FL 32308 850-922-5873 AHCA No. 2004002891 Page 3 of 3 Final Order STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION THERAPEUTIC WHEELCHAIR SPECIALISTS, INC., Petitioner, vs. AHCA No. 2004002891 CASE No. 04-1884 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ! JOINT STIPULATION AND SETTLEMENT AGREEMENT Respondent, Agency for Health Care Administration (hereinafter the “Agency’) through their undersigned representatives, and Therapeutic Wheelchair Specialists, Inc. (hereinafter "Petitioner’), pursuant to Section 120.57(4), Florida Statutes, each individually a “party”, collectively as “parties”, hereby enter into this Joint Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Therapeutic Wheelchair Specialists, Inc. is a home medical equipment provider licensed pursuant to Chapter 400, Part X, Florida Statutes (2003), and Chapter 59A-25, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Therapeutic Wheelchair Specialists, Inc., pursuant to Chapter 400, Part X, Florida Statutes, and Chapter 59A-25, Florida Administrative Code; and WHEREAS, the Agency served Therapeutic Wheeichair Specialists, Inc. a notice of intent to impose Jate fine on April 8, 2004, notifying the party of its intent to impose an administrative fine for FIVE HUNDRED AND 00/100 DOLLARS ($500.00); and AHCA No. 2004002801 Page 1 of 5 Settlernent Agreement fd WdES:E8 pe@e de “UTIL sree 22 Tr6: “ON xbS Shi: ia WHEREAS, Therapeutic Wheelchair Specialists, Inc. requested a formal administrative hearing in documentation received by the Agency on April 13, 2004; and WHEREAS, the parties have agreed that a fair, efficient and cost effective resolution of this dispute would avoid the expenditure of substantial surns to litigate the dispute; and WHEREAS, the parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 3. Upon full execution of this Agreement, Therapeutic Wheelchair Specialists, Inc. agrees to a withdrawal of its Request for Formal Hearing; agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), a formal proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and declaratory and ail writs of relief in any court or quasi-court (DOAH) of competent jurisdiction. Provided, however, that no agreement herein shall be deemed a waiver by either party of its right to judicial enforcement of this stipulation. 4. Upon full execution of this Agreement, Therapeutic Wheelchair Specialists, Inc. agrees to pay TWO HUNDRED FIFTY AND 00/100 DOLLARS AHCA No. 2004002891 Page 2 of 5 Settlement Agreement Ed WdPB:£a peBe de “UNL SPBQ 2ce TPE: “ON xed SML > WOas ($250.00) to the Agency within 30 days of the entry of the Final Order. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in the Circuit Court in Leon County, Florida. 5. By executing this stipulation, Therapeutic Wheelchair Specialists, Inc. does not admit, and the Agency asserts the validity of the allegations raised in the notice of intent letter or administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against Therapeutic Wheelchair Specialists, inc. as a result of the application received on February 13, 2004, which was untimely. 6. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement. 7. Each party shall bear its own costs and attorney fees. 8. This Agreement shall become effective on the date upon which it is fully executed by ail the parties. 9. Therapeutic Wheelchair Specialists, Inc., for itself and for its related or tesulting organizations, its successors or transferees, attorneys, heirs and executors or administrators, does hereby discharge the Agency for Health Care Administration, and its agents, representative, 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 related to this matter and the Agency’s actions, 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 Therapeutic Wheelchair Specialists, Inc. or related facilities. AHCA No. 2004002891 Page 3 of 5 Settlement Agreement td WdrO:fe rae de “UNL SPGQ 2c TRE: "ON XUS Sh : Woes 10. The Agency for Health Care Administration does hereby discharge Therapeutic Wheelchair Specialists, Inc. 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 related to this matter and the Agency's actions, 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 for Health Care Administration. 11. | This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph nine (9) of this Agreement. 12. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 13. | This Agreement contains the entire understandings and agreements of the parties. 14. This Agreement supercedes any prior oral or written agreements between the parties. 15. A facsimile signature contained herein shall be as valid and binding as an original signature thereof. THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK AHCA Na. 2004002891 Pane 4 of 5 Settlement Agreement Sd WdSB:£8 r@@e ce “UNL SrBB 22£ Tr6: “ON XU4 SML: Woes 16. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. or Therapeutic WheelchairgJames P. Mars pecialists, Inc. President 5920 Palmer Boulevard Div. of Heglth Quality Assurance Agency for Health Care Administration 2727 Mahan Drive, MS #9 Sarasota, FL 34232 Tallahassee, FL. 32308 DATED: vil, DATED: 6/27 /o¥ Lit BIE Valda Clark Christian, General Counsel Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 DATED: “Z% hs fay AHCA No. 2004002891 Page 5 of 5 Settlement Agreement Sd WdSO:Ee pede ec “UNL Spee dd TrG: “ON xb4 smi: WOds FLORIDA AGENCY FOR HEALTH CARE ADMINSTRATION. JEB BUSH, GOVFRNOR MARY PAT MOORE, INTERIM SECRETARY CERTIFIED MAIL--RETURN RECEIPT REQUESTED March 30, 2004 Certified Article Number THERAPEUTIC WHEELCHAIR SPECIALISTS INC 7460 390) 9844 £497 1810 Attention: General Manager SENDERS RECORD 5920 PALMER BLVD SARASOTA, FL 34232 License Number: 82 Complaint Number: 2004002891 RE: NOTICE OF INTENT TO IMPOSE LATE FINE REE ENT LO IMPOSE LATE FINE A fine of $500 is hereby imposed due to the late filing of your renewal application for a Home Mcdical Equipment License. The basis for the decision to impose a late fine for $500 is due to The expiration date on your license is 03/30/2004. The application was received on 02/13/04 and it should have been received no later than 12/31/2003. The Florida Administrative Code states the following in paragraph 59A-25,005(3)(a)(2): “IF the provider fails to submit an application for renewal of a license within ninety days before the expiration date of the existing license, as specified in Section 400.931(8), F.S., a $50 fine per day, not to exceed $500, will be levied. If the application is received after the required filing date, but exhibits a hand-canceled postmark from the U.S. Post Office, or delivery documentation by a cartier service, dated on or before the required filing date, no fine will be levied.” To Pay Now: Send a check payable to the Agency for Health Care Administration along with a copy of this notice to the following address: AHCA Home Care Unit #34 2727 Mahan Drive Tallahassee, Florida 32308 2727 Mahan Drive @ Mail Stop #34 Visit AHCA Onfine ar ice thessec, FE. 32108 ww fdhe.state fl us THERAPEUTIC WHEELCHAIR SPECIALISTS INC HME Late Fine Page 2 EXPLANATION OF RIGHTS Pursuant to Section 120.569, Florida Statutes, (F.S.) you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. ' If you do not dispute any issues of material fact (you admit them), you will be afforded an informal hearing under Section 120.57(2), F.S. At an informal hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violation set out in the Notice of Intent. Mediation under Section 120.573, F.S. is not available in this matter. Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for hearings shall be filed with the’ Agency within twenty-one (21) days of receipt of this letter. Failure to submit either payment or a request for hearing will result in the entry of a final order imposing the fine sought. Any request shall be sent to Richclle Cook, Program Administrator, 2727 Mahan Drive, Building 1, Mail Stop 34, Tallahassee, FL 32308. Please include a copy of this Notice of Intent with the request. Coeds Richelle Cook Program Administrator

Docket for Case No: 04-001884