STATE OF PLORIDA DIVISION oF ADMINISTRATIVE HEARINGS SA-PG ORLANDO, Luc, d/b/a PALM GARDEN OF ORLANDO, Petitioner, vs. CASE NO AGENCY FoR HEALTH CARE ADMINISTRATION, . Respondent. / Pa SA-PG WEST PALM BEACH, Luc, d/b/a Ed PALM GARDEN oF WEST PALM BEACH, = a Petitioner, vs. AGENCY FoR HEALTH CARR ADMINISTRATION, Respondent , . / FINAL ORDER ERR LSIMIgy 30 ROISTAIG nO: Sz AYH aon T Y SALLY 05-4664Mpr CASE No. 05-4664MprT Peter Lewis, its attorney of record. Based on the foregoing this Proceeding is CLOSED. . <2 FS DONE and ORDERED on thig the 225 aay of RV 4 , 2006, in Tallahassee, Leon County, Florida. Uf Dhlan Levine, Secretary Agency for Health Care Administration CASE No. 05~-4664mMpr Copies furnished to: Goldsmith, Grout, and Lewis, Pia. ATIN: Peter A Lewis, Esquire Suite 200 307 West Park Avenue Tallahassee, Florida 32308 Debora Fridie, Esquire Attorney for Agency Agency for Health Care Administration 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 The Honorable Daniel m, Kilbride Administrative Law Judge The DeSoto Building 1230 Apalachee Parkway Tallahassee, Plorida 32399-3069 Medicaid Program Integrity, MS #6 CASE No. 05-4664mpr CERTIFICATE OF SERVICE TE, SERVICE addressees by U.S. Mail on this the ZH day of ee , 2006, Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA DIVISION SA-PG ORLANDO, LLC, d/b/a PALM GARDEN OF ORLANDO, Petitioner, AGENCY FoR HEALTH CARE ADMINISTRATION, Respondent. / SA-PG WEST PALM BEACH, LLC Petitioner, d/b/a PALM GARDEN OF WEST PALM BEACH, vs. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / ee STIPULATION AND AGREEMENT AS TO AHCA v. PALM GARDEN OF WEST PaLM BEACH The Respondent, ADMINISTRATION (a/k/a “ANCA” Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE or “the Agency”), and the WEST PALM BEACH, BEACH”) SA~PG WEST PALM BEACH, LLC, d/b/a PALM GARDEN OF (a/k/a “PROVIDER” agree as follows: or “PALM GARDEN OF WEST PALM by and through the undersigned, hereby Stipulate and OF ADMINISTRATIVE HEARINGS CASE NO. 05-4664mpr Case No. 05-4664MPI C.I. No. 05-3487-000 Stipulation and Agreement as to Palm Garden of West Palm Beach v. AHCA 1. The two parties enter into this agreement for purpose. of memorializing the resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, operating under provider number 025725700. 3. In its Final Agency Audit Report C.I. No. 05-3487-000 (the "Audit Letter") AHCA notified PROVIDER, Palm Garden of West Palm Beach, that 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 repayment of an overpayment in the amount of $28,404.20. In response, PROVIDER petitioned for a formal administrative hearing with the Division of Administrative Hearings (DOAH), Case No. 05-4664MPI, which was consolidated by Order of the Administrative Law Judge with the case of AHCA v. SA-PG Orlando, LLC, d/b/a Palm Garden of Orlando. After the provider requested a formal hearing, AHCA reviewed additional information that was previously unavailable to them. Based upon that review, AHCA adjusted the overpayment to $24,771.36 for C.i. Number 05-3487-000. PROVIDER has agreed to pay the adjusted overpayment of $24,771.36 in full plus some of AHCA’s investigative costs, in the amount of $500.00, for a total repayment amount of $25,271.36. Page 2 of 10 Case No, 05-4664MPI c.2. No, 05-3487-000 Stipulation and Agreement as to Palm Garden of West Palm Beach v. AHCA 4, In order to resolve this matter without further administrative proceedings, PROVIDER, Palm Garden of West Palm Beach, and AHCA expressly agree as follows: (a) AHCA will accept the payment set forth herein as settlement of the overpayment issues arising from the MPI review cited in paragraph 3 above. (b) Within thirty (30) days of issuance of the Final Order, PROVIDER agrees to make a single payment to ABCA of Twenty-Five Thousand Two Hundred Seventy-One and 36/100 Dollars ($25,271.36). Of this amount, $24,771.36 is to reimburse the Medicaid program for overpayments, and $500.00 is to reimburse AHCA for investigative costs. AHCA retains the right to perform a 6-month follow-up review. (c) PROVIDER is responsible for ensuring timely delivery of the payment. Failure to timely make the payment will render the balance due and payable immediately, with interest, and interest will continue to accrue until the entire balance is paid. Page 3 of 10 Case No. C.I. No. Stipul Paim G ut 05-4654MPT 05-3487-C600 (e) on and Agreement as to jen of West Palm Beach v. AHCA (d) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all liabilities arising from the findings in the audit referenced as C.I. 05-3487-000. 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. PROVIDER agrees to fully cooperate with any follow up reviews conducted by the Agency. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a stipulation and agreement and shall reference the C.I. Number and the Provider Number. 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 Page 4 of 10 05-4664MFIT 05-3487-000 ion and Agreement a den of West Palm Beach v. AHCA this agreement from any monies due and owing to PROVIDER for any Medicaid claims. 7. AHCA reserves the right to enforce this Stipulation and Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 8. Except as specifically set forth in paragraphs 3 and 4(b) above with regard to AHCA’s investigative costs, the parties agree to bear their own attorney’s fees and other costs, if any. 9. The signatories to this Agreement, acting ina representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Stipulation and Agreement to AHCA; however a facsimile copy shall be sufficient to enable AHCA to cancel a hearing scheduled in this case. 10. This Agreement shall be construed in accordance with co he provisions of the laws of Florida. Venue for any action fe rising from this Agreement shall be in Leon County, Florida. Page 5 of 10 c. -600 Ss m and Agreement as to Palm den of West Palm Beach v. AHCA li. 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. 142. 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. This Stipulation and Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be resolved because the parties have agreed to the terms contained within this + agreement. Page 6 of 10 05-4664MPT 05-3487-000 and Agreement as to 1 of West Paim Beach v. AHCA ‘ome a CO tu it 13. PROVIDER expressly waives in this matter its right to any hearing pursuant to §§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 the Agency should issue a Final Order which is consistent with the terms of this stipulation and agreement, adopts this agreement and closes this matter. 14. Provider does hereby discharge the State of Florida, Agency for Health Care Administration, 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, C.1I. No. 05-3487-000, and AHCA’s actions herein, 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 Provider. 15. This Stipulation and 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. Page 7 of 10 05-46G4MPI 05-3487-000 a en of West Palm Beach v. 16. To the extent that any provision of this Stipulation and 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 Stipulation and Agreement. 17. This Stipulation and 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 in this Stipulation and Agreement. 19. This Stipulation and Agreement shall be in full force and effect upon execution by the respective parties in counterpart. Page 8 of 10 yw OG Je fue wok PETITIONER SA-PG ORLANDO, D/B/A PALM GARDEN OF ORLAN - T (3/ het 22, Boel peg ? 3 cA BY (Printed name and title) Date: _ , 200 GOLDSMITH, GROUT, & LEWIS, P.A. ae CNA BY PETER A. LEWIS, ESQUIRE Attorney for Palm Garden of Orlando Date: re Looe, a) , 200 6 ia Page 9 of 10 05-4664MPA case Wo, c.I. No. 05~3497-000 y stipulation and Agreement 45 to aa 4 5 Palm Garden of West Palm Beach ¥. BRACA I west ‘Pam [2« Teen PETTTIONER SA-PG eRLANDG, Ll . a rome D/B/A PALM GARDEN OF ORLANDG; A OE ! Wesr \ wu Deere O BY: mene OALRO, ADMIUNETEATTE (Printed name and title) Date: eas: W 200 ¥ t BY: PETER A. LEWIS, RSQUIRE attorney for Palm Garden of Orlando Page 9 of 10 RESPONDENT AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Zz. JAMES D. BOYD Inspector General Date: LYE AF , 2004 CHRISTA CALAMAS General Counsel Date: Hpnl 10, 200 (9 14 f Pudet . DEBORA E. FRIDIE Assistant General Counsel Date: Mar cA 23 , 200 G Page 10 of 10

Docket for Case No: 05-004664MPI