STATE OF FLORIDA EY Pot an DIVISION OF ADMINISTRATIVE HEARINGS : LHP g3 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. CASE NO. 06-0790MPI AUDIT C.1. NO. 06-3985-000 MEDICAL DIAGNOSTIC PROVIDER NO. 030726200 LABORATORIES, LLC, RENDITION NO.: AHCA-06-2 du:@ -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 5-5 day of _ screws. _, 2006, in Tallahassee, Florida. fo Christa Calamas, Secrétary 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 Il, Esquire Agency for Health Care Administration (Interoffice Mail) Jeffrey J. Sherrin, Esquire O’Connell and Aronowitz, P.C. 54 State Street Albany, New York 12207 (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 Jill Smith, Medicaid Program Integrity Maryann Alliegood, Finance and Accounting CERTIFICATE OF SERVICE T 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 DSi tay of C tthe y~_, 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 ie a i ma ry DIVISION OF ADMINISTRATIVE HEARINGS oben STATE OF FLORIDA, 7th OCT 27 Aik 18 AGENCY FOR HEALTH CARE ASIOR OF ADMINISTRATION, GIVES ADMINISTRATIVE Petitioner, HEARINGS vs. CASE NO. 06-0790MPI CILNO. 06-3985-000 MEDICAL DIAGNOSTIC LABORATORIES, LLC, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Medical Diagnostic Laboratories, LLC (“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 030726200 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated January 13, 2006, 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 $645,509.79. In response to the January 13, 2006 audit letter, PROVIDER filed a petition for formal administrative hearing. It was assigned DOAH Case No. 06-0790. Medical Diagnostic Laboratories, LLC Settlement Agreement 4, Subsequent to the original audit and in preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result of the additional review, AHCA determined the overpayment should be adjusted to $169,838.68. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA agree as follows: (1) (2) (3) 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 one hundred sixty nine thousand eight hundred thirty eight dollars and sixty eight cents ($169,838.68) plus one thousand dollars ($1,000) in fines, for a total of one hundred seventy thousand eight hundred thirty eight dollars and sixty eight cents ($170,838.68). This fully and completely settles all claims in these proceedings before the Division of Administrative Hearings (DOAH Case No. 06-0790). 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. 06- 3985-000. Medical Diagnostic Laboratories, LLC Settlement Agreement (4) PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were determined to be “not covered by Medicaid” for the reasons which were 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. 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, 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 Circuit Court, 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, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no Medical Diagnostic Laboratories, LLC Settlement Agreement 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. With respect to the claims. that are the subject of this audit 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. With respect to the claims that are the subject of this audit 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. 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 shali not affect any other provision of this Agreement. Medical Diagnostic Laboratories, LLC 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. MEDICAL DIAGNOSTIC LABORATORIES, LLC Dated: Q-|2-Olp , 2006 BY: ah Mordec At 5 (Print name) irs: Chief Eyeeubve OLGol AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 fone 34 Dated: Bc2S , 2006 Jarfiés D. Boyd “ Inspector General a Dated: za LY. , 2006 William Roberts Dated: Yt AI __,2006 Acting General Counsel L, Williath Porter II Assistant General Counsel PROVIDER ACKNOWLEDGEMENT STATEMENT T_€h Mardecha, fl Ph. Ds , on behalf of Medical Diagnostic (insert printed full name here) Laboratories, LLC, a Medicaid provider operating under provider number 0307262-00, do hereby acknowledge the obligation of Medical Diagnostic Laboratories, LLC, to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Medical Diagnostic Laboratories, LLC, acknowledges that Florida Medicaid policy requires: 1) The Independent Laboratory Coverage and Limitations Handbook, (March 2003), states under Duplicate Billing Not Allowed, that “Additional molecular diagnostic codes 83890-83912 may not be billed in conjunction with direct, amplified or quantification procedure codes." Date: O-44-0l By: SN (signature) Chie Cyerubve Ofc C (title) Return completed acknowledgement statement to Medicaid Program Integrity. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated January 13, 2006 C.1. 06-3985-000 Corrective Action Plan — Acknowledgement Statement A “corrective action plan” is the process or plan by which the provider will ensure future compliance 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 alleged 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: Jill Smith 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 January 13, 2006 CL. 06-3985-000

Docket for Case No: 06-000790MPI