STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JACOBO A. CRUZ, M.D., Petitioner, vs. CASE NO. 04-4626MPI PROVIDER NO. 048405900 STATE OF FLORIDA, AUDIT C.I. NO. 00-1473-000 AGENCY FOR HEALTH CARE Rendition No. AHCA-06- -S-MDP ADMINISTRATION, cs Respondent. = “Tl ema / 2 F gua INAL ORDER > om = 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. PO ’ DONE and ORDERED on this the 23 “day of _ ~~ , 2006, in Tallahassee, Florida. re Alan 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Kerry A. Schultz, Esquire Lozier Thames & Frazier, P.A. Post Office Box 408 Pensacola, Florida 32591-0408 (U.S. Mail) P. Michael Ruff 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; Meciicaid-Progranrintegrity 0) Maryann Alliegood, Finance and Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has ; 2 Gas been furnished to the above named addressees by U.S. Mail on this th day of “Be , 2006. Richard Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 E | STATE OF FLORIDA TNO MAY 2b A Ht: Yo. DIVISION OF ADMINISTRATIVE HEARINGS OMVISIOl OF JACOBO A, CRUZ, M.D., ADMINISTRATIVE HEARINGS Petitioner, vs.- CASE NO. 04-4626MPT , PROVIDER NO. 048405900 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, . Respondent. / =" SETTLEMENT AGREEMENT SETTLEMENT AGREEMENT : STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION : (“AHCA” or “the Agency”), and Jacobo A. Cruz, M/D. (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as. follows: 1. The two parties enter into this agreement for the purpose of memorializing the Tesolution to this matter. . 2. PROVIDER is a Medicaid provider in the State of Florida, Provider number 048405900 and was a provider during the andit Period. 3, In its Final Agency Audit Report (final agency action) dated October 27, 2004, or in part, has been inappropriately paid by Medicaid. The Agency sought recoupment of this Overpayment, in the amount of $35,092.82. In tesponse to the audit letter dated October 27, 2004, PROVIDER filed 4 petition for a formal administrative hearing, which was assigned DOAH Case No, 04-4626. Jacobo A. Cruz, M.D. Settlement Agreement 4. Subsequent to the original audit that took place in this matter and in preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result, AHCA determined that the overpayment was adjusted to , $28,455.46. After additional document review AHCA determined that the overpayment was adjusted to $20,294.34. 5. In order to resolve this ‘matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) AHICA agrees to accept the payment set forth herein i in settlement of the overpayment issues arising from the MPI review. (2) Within thirty days of entry of the final order, PROVIDER agrees to make a lump sum payment of twenty thousand two hundred ninety four dollars ’ and thirty-four cents ($20,294.34) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No, 04-4626). AHCA retains the right to perform a 6 month follow-up review. . (3) 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. 00-1473- 000. , » (4) 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. Jacobo A. Cruz, M.D. Settlement Agreement 6. ) Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable * Post Office Box 13749 Tallahassee, Florida 32317-3749 7. 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. 8. AUICA 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. 9. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 10. Each party shall bear its own attorneys’ fees and costs, if any. 11. 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 patties. . 12. 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. 13.‘ 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. Jacobo A. Cruz, M.D. Settlement Agreement 14. 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. 15. 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. 16. 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. 17. 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 80 prohibited, and such prohibition shall not affect any other provision of this Agreement. 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. Jacobo A. Cruz, M.D. “Settlement Agreement . 20. ‘This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. — JACOBO A. CRUZ, M.D. —— wear 2° , 2006 RY: JAtoBo CRuz mp (Print name) TTS: AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: S25 2006 J . Boyd ; Inspector General ‘ C rn (lasers Dated: S/1¢ 2006 Christa Calamas General Zounsel ”

Docket for Case No: 04-004626MPI