Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: VATSALA S. SASTRY, M.D.
Judges: ELLA JANE P. DAVIS
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Oct. 31, 2005
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, January 5, 2006.
Latest Update: Dec. 24, 2024
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION, 7h Pres Hr Sg
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VATSALA S. SASTRY, MD., ‘
Petitioner,
VS. CASE NO. 05-4029MPI
PROVIDER NO. 377455400
STATE OF FLORIDA, AUDIT C.1. NO. 01-1116-000
AGENCY FOR HEALTH CARE
ADMINISTRATION, RENDITION NO.: AHCA-0'7- O24 -S-MDO
Respondent.
/
FINAL ORDER
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.
DONE and ORDERED on this the AT day of Sb. , 2007, in
Tallahassee, Florida.
pes Gee C. Lh Meta)
Pe sxe 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
(nteroffice Mail)
Robert Penezic, Esquire
Broad & Cassel
P.O. Box 14010
Ft. Lauderdale, Florida 33302
(U.S. Mail)
E. J. Davis
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Tim Byrnes, Chief, Medicaid Program Integrity
Vicki Remick, 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 day of each, , 2007.
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 oe
DIVISION OF ADMINISTRATIVE HEARINGS @> Mp “A Ln
VATSALA S. SASTRY, M.D., “L)
Petitioner, IES yer
CASE NO. 05-4029MPI Aiiftees iy
vs. C.1. No.: 01-1116-000 oS
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and Vatsala S. Sastry, 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
resolution to this matter.
2. PROVIDER is a Medicaid provider in the State of Florida, provider number
377455400 and was a provider during the audit period.
3. In its Final Agency Audit Report (final agency action) dated September 9, 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, had been inappropriately paid by Medicaid. The Agency sought recoupment of this
overpayment in the amount of $60,373.56. In response to the September 9, 2005 audit letter,
PROVIDER filed a petition for formal administrative hearing. It was assigned DOAH Case No.
05-4029MPI.
Vatsala S. Sastry, M.D.
Settlement Agreement
4. In order to resolve this matter without further administrative proceedings,
PROVIDER and the AHCA 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.
Within thirty days of entry of the final order, PROVIDER agrees to make
a lump sum payment of sixty thousand three hundred seventy three dollars
and fifty-six cents ($60,373.56). This fully and completely settles all
claims in these proceedings before the Division of Administrative
Hearings (DOAH Case No. 05-4029). AHCA retains the right to perform
a 6 month follow-up review, to assure that PROVIDER is in compliance
with rules and law.
PROVIDER and AHCA agree that full payment, as set forth above,
resolves and settles this case completely. It will release both parties from
any liabilities arising from the findings in the audit referenced as C.I. 01-
1116-000.
PROVIDER agrees that it will not rebill the Medicaid Program in any
manner for claims that were determined 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
Vatsala S. Sastry, M.D.
Settlement Agreement
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. The provider does, however, agree to
following corrective action.
9. PROVIDER acknowledges their obligation to adhere to state and federal
Medicaid laws, rules, provisions, handbooks and policies.
10. PROVIDER acknowledges that Medicaid policy states:
(a) Medicaid Policy defines the varying levels of care and expertise required for the
evaluation and management procedure codes for office visits.
(b) Medicaid policy specifies how medical records must be maintained. Medicaid
requires documentation of the services and considers payments made for services
not appropriately documented an overpayment.
(c) Medicaid policy requires that services performed be medically necessary for the
diagnosis and treatment of an illness and must meet the Medicaid criteria for
medical necessity.
Vatsala S. Sastry, M.D.
Settlement Agreement
11. Vatsala S. Sastry, M.D., a Medicaid provider operating under provider number
3774554 00, does hereby acknowledge the obligation of Vatsala S. Sastry, M.D. to adhere to
state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally,
Vatsala S. Sastry, M.D. acknowledges that Medicaid policy requires providers to follow the
guidelines set forth in the applicable Rules and Medicaid fee schedules, as promulgated in the
Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid
cannot pay for services that do not meet these guidelines.
12. Each party shall bear its own attomeys’ fees and costs, if any.
13. 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.
14. 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 Circuit Court, Leon
County, Florida.
15. 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.
16. 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
Vatsala S. Sastry, M.D.
Settlement Agreement
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.
17. | 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.
18. 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.
19. 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.
20. This Agreement shall inure to the benefit of and be binding on each party’s
successors, assigns, heirs, administrators, representatives and trustees. .
21. All times stated herein are of the essence of this Agreement.
Vatsala S. Sastry, M.D.
Settlement Agreement
22. This Agreement shall be in full force and effect upon execution by the respective
parties in counterpart.
VATSALA S. SASTRY, M.D.
5
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BY: | SAS wes
(Print name)
ITS:
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
7
ade A Kens Dated: 2-7 2009
Linda Ke :
Inspector General
7
Cavell Fcte Grrrl Comet Dated: o2- 12 , 200%
Williaa Roberts
Acting General Counsel
Dated: 7 | a 2008
L. Wflliam Porter II
Assistant General Counsel
Docket for Case No: 05-004029MPI
Issue Date |
Proceedings |
Mar. 05, 2007 |
Final Order filed.
|
Oct. 03, 2006 |
Amended Motion to Re-open filed.
|
Sep. 27, 2006 |
Motion to Re-open filed. (DOAH CASE NO. 06-3922MPI ESTABLISHED)
|
May 23, 2006 |
Notice of Substitution of Counsel and Request for Service (filed by L. Porter).
|
Jan. 05, 2006 |
Order Closing File. CASE CLOSED.
|
Jan. 04, 2006 |
Joint Motion to Remand Case to the Agency for Health Care Administration filed (without Certificate of Service).
|
Nov. 16, 2005 |
Order of Pre-hearing Instructions.
|
Nov. 16, 2005 |
Notice of Hearing (hearing set for January 24 and 25, 2006; 9:30 a.m.; Tallahassee, FL).
|
Nov. 09, 2005 |
Motion to Correct Designation of Parties in Style of Case filed.
|
Nov. 09, 2005 |
Joint Response to Initial Order filed.
|
Nov. 03, 2005 |
Notice of Service of Interrogatories, Request for Admissions, and Request for Production of Documents filed.
|
Nov. 01, 2005 |
Initial Order.
|
Oct. 31, 2005 |
Petition for Formal Administrative Hearing filed.
|
Oct. 31, 2005 |
Final Audit Report filed.
|
Oct. 31, 2005 |
Notice (of Agency referral) filed.
|