an Oy STATE OF FLORIDA > i AGENCY FOR HEALTH CARE ADMINISTRATION”. hist, HEALTHPARK SURGERY CENTER, “Uggs LLC., Petitioner, Formerly DOAH CASE NO. 06-1267 AHCA CASE NO. 2006003093 BMHC CASE ID 20060113-002 VS. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER This matter involves a Petition for Formal Administrative Hearing (“Petition”) that was filed with the Agency on March 9, 2006 in the above-referenced matter. On April 12, 2006, the Agency referred the Request to the Division of Administrative Hearings for assignment to an Administrative Law Judge (“ALJ”). On March 31, 2006, the ALJ entered an Order Granting Continuance, asking the parties to advise the ALJ of the status of the case by June 21, 2006. - On July 5, 2006, the ALJ entered an Order Closing File, which relinquished jurisdiction of the matter back to the Agency, based on the fact that the parties had failed to advise the ALJ of the status of the case as requested. On April 8, 2008, the Agency entered an Order to Show Cause, asking the parties to show cause why a final order should not be entered in this matter since there had been no activity since July of 2006. None of the parties responded to the Order to Show Cause. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioner’s Petition is dismissed with prejudice and the Agency’s February 14, 2006 Determination is hereby upheld. Unless it has already done so, Publix Supermarkets, Inc. shall submit the correct reimbursement amount as stated in the Agency’s February 14, 2006 Determination to Healthpark Surgery Center, L.L.C. within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Anna Ohlson, R.N., AHCA WC Med Services, Division of Worker’s Compensation, 200 East Gaines Street, Tallahassee, Florida 32399-4229. Petitioner shall govern itself accordingly. DONE and ORDERED this /S dayof__ 7 rae , 2008, in Tallahassee, Florida. HOLLY BENSON, Secretary AGENCY FOR HEALTH CARE ADMINIS NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH. SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail to the persons named below on this /Z! day of A Oh » 2008. RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3. Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: ; Honorable T. Kent Wetherell, II Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060. Stephen K. Boone, Esquire Boone, Boone, Boone, Koda & Frook, P.A. Post Office 1596 Venice, Florida 34284 Mari H.. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Publix Super Markets, Inc. Post Office Box 32016 Lakeland, Florida 33802 Qmedtrix Post Office Box 9414 Woodland Hills, California 91365 Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance

Docket for Case No: 06-001267