STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, MELISSA PHARMACY DISCOUNT CORPORATION, d/b/a HOLGUIN PHARMACY, Petitioner, vs. CASE NO. 05-1521MPI PROVIDER NO. 103247000 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AUDIT C.I. NO. 00-1917-000 Respondent. io) / cag pe Zn Go? FINAL ORDER foregoing, this file is CLOSED. 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 ret DONE and ORDERED on this the /7 z day of Tallahassee, Florida. Ses , 2006, in fe hoasinfior| Adan 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 Copies furnished to: Donna Riselli, Esquire Agency for Health Care Administration (Interoffice Mail) Benjamin R. Metsch, ESQUIRE METSCH & METSCH, P.A. Counsel for Provider Aventura Corporate Center 20801 Biscayne Boulevard, Suite 307 Aventura, Florida 331 80-1423. (U.S. Mail) John G. VanLaningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Kathryn Holland, Medicaid Program Integrity Maryann Alliegood, Finance and Accounting 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 aay of Jena—-—_, 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 STATE OF FLORIDA eTLED AGENCY FOR HEALTH CARE ADMINISTRATION 20 JUN 21 ATi tb MELISSA PHARMACY DISCOUNT OIVISTOR OF CORPORATION, d/b/a HOLGUIN PHARMACY, ADMIMISTRATIVE HEARINGS Petitioner, vs. CASE NO. 05-1521MPI C.1. AUDIT #00-1917-000 STATE OF FLORIDA, PROVIDER NO.103247000 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT PEMLEEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA" or “the Agency”), and MELISSA PHARMACY DISCOUNT CORPORATION d/b/a HOLGUIN PHARMACY, (“PROVIDER”), through their respective counsel, hereby stipulate and agree as follows: 1. This Agreement is entered into for the purpose of memorializing the final resolution of the matters set forth in this Agreement. 2. PROVIDER is a Medicaid provider in the State of Florida and was a Medicaid provider during the audit period October 20, 1999 through duly 20, 2001. 3. in its final agency audit report dated November 22, 2004, 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 overpayment in the amount of $56,930.11. In response to the audit letter dated November 22, 2004, PROVIDER fiied a petition for a formal administrative hearing. Subsequently and after additional information was provided, AHCA reviewed the disputed claims and determined the outstanding amount of overpayment should be adjusted to $18,606.07. 4, In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (1) (2) (3) (4) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. PROVIDER agrees to pay the adjusted overpayment amount of $18,606.07 plus costs in the amount of $12,000.00, for an aggregate payment of $30,606.07 to be paid in one lump sum. Payment of the aggregate amount of $30,606.07 will constitute full and complete settlement of all claims in the proceedings before the Agency for Health Care Administration related to audit Cl No. 00- 1917-000. Within thirty days of receipt of the final order, PROVIDER agrees to make the lump sum payment in the aggregate sum of $30,606.07, as referenced in Paragraph 4(2) hereinabove. 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. No. 00-1917-000. (5) PROVIDER agrees that it will not re-bill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 6. 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. 7. 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. 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 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 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 shail be deemed jointly drafted and written by ail 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. MELISSA PHARMACY DISCOUNT CORPORATION, d/b/a HOLGUIN PHARMACY BS = Dated: ty , 2006 BY: Rol Acdines Te Luk Dated: stuf , 2006 Benjamin R. Metsch, ESQUIRE ~ METSCH & METSCH, P.A. Counsel for Provider Aventura Corporate Center 20801 Biscayne Boulevard, Suite 307 Aventura, Florida 33180-1423 Telephone: (305) 792-2540 Facsimile: (305) 792-2541 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Lnastobirrh Dated: ES? , 2006 Jamé& D. Boyd “ Inspector General Cluiifa Orbamors pated: S/S ———_a006 Christa Calamas General Counsel ak yw eK Linn Dated: O-| He , 2006 Kim Kellum , Chief Medicaid Counsel ek cisckk Mr tor Dated: ..{— / Ze , 2006 “Donna Riselli Assistant General Counsel

Docket for Case No: 05-001521MPI