STATE OF FLORIDA s AGENCY FOR HEALTH CARE ADMINISTRATJONecg a9 4 11: {5 FISHER’S PHARMACY, INC. d/b/a FISHER’S PHARMACY, Petitioner, vs. CASE NO. 05-2275MPI PROVIDER NO. 104725600 STATE OF FLORIDA, AUDIT C.I. NO. 02-0511-000-3 AGENCY FOR HEALTH CARE ADMINISTRATION, RENDITION NO.: AHCA-05-0}538-S-MDO Respondent. = a FINAL ORDER au 0 a THE PARTIES resolved all disputed issues and executed'd Settlement a) Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. a DONE and ORDERED on this the Z6~ day of S@V7E%Z&L_, 2005, in Tallahassee, Florida. or Man 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) William M. Furlow, Esquire Akerman Senterfitt Post Office Box 1877 Tallahassee, Florida 32302-1877 (U.S. Mail) Stephen Dean Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Ramona Stewart, Medicaid Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE J] 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 30” day of ptf , 2005. 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 DIVISION OF ADMINISTRATIVE HEARINGS FISHER’S PHARMACY, INC. d/b/a FISHER’S PHARMACY, Petitioner, vs. CASE NO. 05-2275 PROVIDER NO. 104725600 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Fisher’s Pharmacy, Inc. d/b/a Fisher’s Pharmacy (“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 resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 104725600 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated January 14, 2005, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI), Office of the AHCA Inspector General, indicated that certain claims, in whole or in part, has been inappropriately paid by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $23,070.33. In response to the andit letter dated January 14, Fisher's Pharmacy Settlement Agreement 2005, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 05-2275. 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 $20,527.04. 5.0 on order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (2) Within ten days of entry of the final order, PROVIDER agrees to make a lump sum payment of twenty thousand five hundred twenty-seven dollars and four cents ($20,527.04) plus one thousand five hundred forty-three dollars and twenty nine cents ($1,543.29) in investigative costs, for a total of twenty two thousand seventy dollars and thirty three cents ($22,070.33) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 05-2275). 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.J. 02-0511- 000-3. Fisher's Pharmacy Settlement Agreement (4) PROVIDER agrees that it will not rebill the Medicaid Program in any manner fot claims that were not covered by Medicaid, which are the subject of the audit in this case. 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. AHICA 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 parties. 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. Fisher's Pharmacy Settlement Agreement 13. This Agreement constitutes the entire agreement between PROVIDER and the AHCA, including anyone acting for, associated with or employed by them, conceming 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. 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 Jaw 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. Fisher's Pharmacy Settlement Agreement 17. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shal] be effective to the extent not so 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. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. FISHER’S PHARMACY, INC. d/b/a FISHER’S PHARMACY i} Dated: “7-3 , 2005 : Jatu Mm Cee hun (Print name) ITS: Pees daw AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-540 Dated: P-2K , 2005 Jamies D. Boyd Inspector General (1 Lewtice. Ca leven’ Dated: 7 [te 2005 Christa Calamas General Counsel - “~ Dated: E-21-8> 9005 L. Wilkam Porter 0 Assistant General Counsel a1/1e/2ea5 87:53 g5a8925085 FISHERS PHARMACY PAGE wl ~ , FIDRIDA AGHINGY TOR HIATT CARE ADNINISTINION @ JES BUSH, GOVERNOR ‘ ALAN LEVINE, SECRETARY =, CERTIFIED MAIL — RETURN RECEIPT No. 7001 0360 0003 3822 7169 January 14, 2005 Provider No: 1047256 00 * License No.: PHOC00I85 Mr. John Rochm, R. Ph., President Fisher's Pharmacy Incorporated d/b/a Fisher's Pharmacy 688 Baldwin Avenue ‘Defuniak Springs, Florida 32433 Jn Reply Refer to _ ; ; FINAL AGENCY AUDIT REPORT Os 397 yn PL C1. No. 02-051 1-000-3/H/RDS Dear Mr. Roehm: Care Administration, Office of Medicaid Program Integrity has completed the review of your Medicaid claims for the procedures specified below for dates of service during the period November 24, 1999, through August 24, 2001. A provisional agency audit report dated December 6, 2002 was sent to you indicating that we had determined you were @ overpaid $23,070.33. Based upon a review of all documentation submitted, we have determined that,you were overpaid $23,070.33 for services that in whole or in part are not covered by Medicaid. This report is not intended to imply that any particuler claim is or was covered, Ata later date, the Agency may again review claims submitted during this period of time. Be advised that pursuant to Section 409.913(23)(a), Florida Statutes (F.S.), the Agency is entitled to recover all investigative, legal, and expert witness costs. Additionally, pursuant to Section 409.913, F.5., this letter shall serve as notice of the Jo)lowing sanction(s): The provider is subject to a comprehensive follow-up review in six months. The Agency for Health This review and the determinations of overpayment were made in accordance with the provisions of Section 409.913, F.S. In determining payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies and the limitations and exclusions found in the Medicaid provider handbooks. In applying for Medicaid reimbursement, providers sre les and Medicaid fee schedules, as required to follow the guidelines set forth in the applicable ra! promulgated in the Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these guidelines. ed to our review of your claims and an requirements. The audit work papers are ede ty 4 hi bit A Visit AHCA onilan at wei fdhe state flus Below isa discussion of the particular guidclines relat explanation of why these claims do not meet Medicaid tray 2727 Mohan Drive + Mait Stop 46 Tallobassee, FL 32308 ‘this particular review. The audit perio Fisher Pharmacy Page 2 attached, referencing the claims that were reviewed and found to be discr determination. . ; REVIEW DETERMINAT IONS) The audit jacluded the review of 2 random sample of selected claims with dates of service during the audit period. The overpayment found in the random sample constitutes the overpayment for d for this review was from Novernber 24, 1999, through *: aymient of $162.12. Attached are the and an itemized listing of epant by this - August 24, 2001. This review identified an overp ‘ overpayment calculations, a summary of documented discrepancies, discrepancies noted in the review of the random sample. , The audit also included a comparison of your Jawful documented product acquisitions with your paid Medicaid claims. The audit period for this review was from November 24, 1999, through August 24, 2001. The drug quantity paid for by Medicaid, in Several instances, exceeded the quantity available to dispense to Medicaid recipients. This review identified an overpayment of $23,070.33. ‘Attached are the overpayment calculations. ' If you are currently involved in a bankruptcy, you should notify your attorney immediately and provide them with a copy of this letter. Please advise your attomey that we need the following information immediately: (1) the date of filing of the bankruptcy petition; (2) the case number, (3) the court name and the division in which.the petition was filed (e.g., Northern, District of Florida, Tallahassee Division); and, (4) the name, address, and telephone number of your attorney. Hf you are not in bankruptcy and you concur with our findings, remit by check in the ammount of $23,070.33. The check must be payable to the Florida Agency for Health Care ‘Administration. Questions regarding payment should be directed to Medicaid Accounts Receivable, (850) 488-5859. To ensure proper credit, be certain your provider number and the audit number (beginning with C.1) are shown on your check, Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable P.O, Box 13749 Tallahassee, Florida 32317-3749 If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Chapter 409.913(27), F.S. Furthermore, pursuant to Sections 409,.913(25) and 409.913(15), F.S., failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by the Agency may result in termination from the Medicaid Program. Yow have the right to request a formal or informal hearing pursuant to Section 120.569, F.S. If a request for a formal hearing is made, the petition must be made in compliance with Section 28-106.201, Florida Administrative Code (F.A.C.) and mediation may be available, Jf a request for an informal hearing is made, the petition must be made in compliance with mle Section 28-106.301, F.A.C. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of xeccipt of @1/18/28a5 e7:53 goassz5a83 FISHERS PHARMACY PAGE 4 , Fisher Pharmacy Page 3 this letter. For more information regarding your hearing and mediation rights, please see” the attached Notice of Hearing and Mediation Rights. @ : Questions should be directed to: Ramona Stewart, Senior Pharmacist, ‘Agency for Health Care Administration, Medicaid Program Integrity, Office of Inspector General, 2727 Maban Drive, Mail Stop #6, Tallabassce, Florida 32308-5403, telephone (850) 921-1802. * Sincerely, D. Kenneth Yon ANCA Adnuinistrator DKY/rds Attachment cc: Medicaid Accounts Reccivable Ramona Stewart 1/18/2085 87:59 — BBeesZ5ES FISHERS PHARMACY Fisher Pharmacy Page 4 HEARING AND MEDIATION RIGHTS ursuant to Sections 120.569 You have the right to Tequest an o| i ‘ 120.57, Florida Statutes. If you disagree wi e foregoing Final Agency A y istrative hearing pursuant to Section © “@& NOTICE OF ADMINISTRATIVE }, Florida Statutes. If you do not dispute the facts stat : peljeve | 2 cal reasons to grant the relief you seek, you may request an informal administrative hearing pursuant to Section 120.57(2), Florida Statutes. Additionally, p' Florida Statutes, mediation may as discussed morc fully below. . ; ¢ written request for an administrative hearing must conform to the requirements of .. fo either Rule 28-106.201(2) or Rule 28-106.301(2), received by the Assistant Bureau Chief by 5:00 P.M. no tater than 21 days FAAR, The address for filing the written request for an admi. ‘Assistant Bureau Chief Medicaid Program Integrity Agency for Health Care ‘Administration : 2727 Mahan Drive, Mail Stop #6 " ” Tallahassee, Florida 32308 on 8 % by 11-inch white paper, and contain: \. Your name, address, telephone number, any Agency identifying number on the FAAR, if known, and name, address, and ielephone number of your representative, if any; An explanation of how your substantial interests will be affected by the action described in the F. ; A statement of when and how you received the FAAR; For a request for formal pearing, a statement of all disputed issues of material fact; For a request for formal hearing, a concise statement of the ultimate facts alleged, as well ag the rules and statutes which entitle you to relief; For a request for formal hearing, whether you request mediation, if it is available; i rt an adjustment to the ammount owed @ The request must be Jegible, For a request for informal hearing, what basis suppo: to the Agency; and A demand for relief. A formal hearing will be held jf there are disputed issues of material fact. Additionally, \ mediation may be available in conjunction with a formal hearing. Mediation jsawaytousca ~- neutral third party to assist the parties in a legal or admninistrative proceeding to Teach & settlement of their case. If you and the Agency agree to mediation, it does not mean that you give up the right to a hearing. Rather, you and the Agency will try to settle your case first with If you request mediation, and the Agency agrees to Agency to‘sct up a time for the mediation and to enter into a mediation agreement. If a mediation agreem matter will proceed having entered into the agreement, unless yo The mediation agreement between you and the Agency mediator, the allocation of costs and fees associated with the mediation, an} of discussions and documents involved in the mediation, Mediators charge hourly fees that must be shared equally by you and the Agency. Ifa written request for an administrative hearing is not timely received you will have waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set forth in the FAAR shall be conclusive and final. Sf NA waw p aspoYs aspyaing Synsay Sish[EUYy 2OL0AUy palEiolg *2U] ‘swaj8hg WOBULIOyN] 33871197] TO/PT/S OF GEIFT/EL QO9STLPOR ADVULAB JOYS} OSU QSSAU) raaiA2ag Jo sag NOqUIN JOplaolg ‘QUIEN JapiAgsd,

Docket for Case No: 05-002275MPI