STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION HD PPR 2) At Og MILTON APONTE, M.D., > Petitioner, =e = “Fi vs. CASE NO. 05-4679MBI@= PF" PROVIDER NO. 259748760 EFT STATE OF FLORIDA, AUDIT C.1. NO. 03-1f15:000 ~ AGENCY FOR HEALTH CARE Rendition No. AHCA-064 — -SMDP ADMINISTRATION, Fee 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 SE bay of APGZEZ_ 2006, in Tallahassee, Florida. pRGE 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) Milton Aponte, M.D. Post Office Box 881027 Port St. Lucie, Florida 34988 (U.S. Mail) Stuart Lerner 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, 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 7 day of _xflrn/ _, 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 FILED 1006 APR 24 PI y2 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS MILTON APONTE, M.D., aiivision GF Petitioner, : HE AR | B i IVE vs. CASE NO. 05-4679 PROVIDER NO. 259749700 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Milton Aponte, 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 259749700 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated July 28, 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 $17,630.03. In response to the audit letter dated July 28, 2005, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 05-4679: Milton Aponte, 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 $15,719.56. 5. In 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 thirty days of entry of the final order, PROVIDER agrees to make a lump sum payment of nineteen thousand four hundred nineteen dollars and fifty-six cents ($19,419.56), which is fifteen thousand seven hundred nineteen dollars and fifty-six cents ($15,719.56) in overpayment, one thousand two hundred dollars ($1,200.00) in costs and a fine of two thousand five hundred dollars ($2,500.00), in full and complete settlement of all claims in this proceeding before the Division of Administrative Hearings (DOAH Case No. 05-4679). 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.I. 03-1115- 000. Milton Aponte, M.D. Settlement Agreement (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. 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 Agreemeni 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. 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. 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, with the exception that the Respondent shall reimburse, as part of this settlement, $1,200.00 in Agency costs of action. ‘This amount is included in the calculations and demand of paragraph 5(2). 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. 13. This Agreement constitutes the entire agreement between PROVIDER and the AHCA, including anyone acting for, associated with or employed by them, concering all Milton Aponte, M.D. Settlement Agreement 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 incorreciness 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 tules 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 nght 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 so prohibited, and such prohibition shall not affect any other provision of this Agreement. Milton Aponte, M.D. Settlement 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. MILTON APONTE, M.D. Dated: 7 / 2/ / , 2006 BY: Millon “oh S doon ¥2LLIF) (Print name) ITS: AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Loews thar Dated: SAS , 2006 Janies D. Boyd . Inspector General (Nerf Colousar Dated: t] & , 2006 Christa Calamas General Counsel lezen. (Cao ~Dated: Mau 4. 2006 L. Willlam Porter II Assistant General Counsel Corrective Action Plan — Acknowledgement Statement A “corrective action plan” is the process or plan by which the provider will ensure future conipliance with state and federal Medicaid laws, rules, provisions, handbooks, and policies. For purposes of this matter, the sanction of a corrective action plan shall take the form of an “acknowledgement statement”, which is a written document submitted to the Agency within 30 days of the date of the Agency action that brought rise . to this requirement. An acknowledgement statement: identifies the areas of non- compliance as determined by the Agency in this Final Audit Report (FAR); acknowledges a requirement to adhere to the specific state and federal Medicaid laws, rules, provisions, handbooks, and policies that are at issue in the FAR; and, must be signed by the provider or its president, director, or owner. The acknowledgement statement is due to Medicaid Program Integrity within 30 days of the issuance of this FAR. Please sign the enclosed statement and return it to: Carolyn Milligan Agency for Health Care Administration Medicaid Program Integrity 2727 Mahan Drive, Mail Stop # 6 Tallahassee, FL 32308-5403 Phone (850) 921-1802 Facsimile (850) 410-1972 Failure to comply with the requirements set forth above may result in the imposition of additional sanctions, which may include monetary fines, suspension, or termination from the Medicaid program. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated 07/28/2005 CI. 03-1115-000 PROVIDER ACIXNOWLEDGEMENT STATEMENT I Miby f 4, hip Or fey, Mion behalf of Milton Aponte, M.D., (insert printed full name here) a Medicaid provider operating under provider number 259749700, do hereby acknowledge the obligation of Milton Aponte, M.D. to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Milton Aponte, M.D. acknowledges that Medicaid policy requires: Medicaid policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. Medicaid uses the Physician’s Current Procedure Terminology (CPT) book, which contains complete descriptions of the standard codes. Medical records must state the necessity for and extent of services provided. The following requirements may vary according to the service rendered: history; physical assessment; chief complaint on each visit; diagnostic test and results; diagnosis; treatment plan, including prescriptions; medications, supplies, scheduling frequency for follow-up or other services; progress reports, treatment rendered; the author of each (medical record) entry must be identified and must authenticate his or her entry by signature, written initials or computer entry; dates of service; and referrals to other services. Medicaid policy requires that the provider must retain all medical, fiscal, professional, and business records on all services provided to a Medicaid recipient. The records must be accessible, legible and comprehensible. Records must be retained for a period of at least five years from the date of service, and must state the necessity for and the extent of services provided. These requirements are currently found in the Florida Medicaid Provider General Handbook, dated October 2003. Prior to this time, they were spelled out in the Medicaid Provider Retmbursement Handbook, HCFA-1500 and Child Health Check-Up Reimbursement Handbook. The Child Health Check-Up (CHCUP) Coverage and Limitations Handbook, Chapter 2, states that CHCUP providers may only bill for one visit, a sick visit or a Child Health Check Up. If the child is sick, the provider should treat or refer the child for the illness and reschedule the Child Health Check Up. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated 07/28/2005 . C.I. 03-1115-000 The Physician’s Coverage and Limitations Handbook, Chapter One, states: If a physician provider employs or contracts with a non-physician health care practitioner who can enroll as a Medicaid provider and that health care provider is treating Medicaid recipients, he must enroll as a Medicaid provider. Examples of non-physician health care practitioners who can enroll as Medicaid providers are: physician assistants, advanced registered nurse practitioners, registered nurse first assistants, physical therapists, chiropractors, etc. 7 : — __yPate: herd DD. (title) By: Return completed acknowledgement statement ¢eMedicaid_Pregranrimtegrity. With re Seartenp anf Aetenow. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated 07/28/2005 C1. 03-1115-000

Docket for Case No: 05-004679MPI