STATE OF FLORIDA _ AGENCY FOR HEALTH CARE ADMINISTRATION AGE moe npn 6 Pe SOUTHEAST PERSONNEL LEASING and LION INSURANCE COMPANY, DOAH CASE NO. 06-1275 AHCA NO. 2005008727 DETERMINATION NO. 20050825-046 Petitioners, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, and LH: Hd 91 dv go 4 ORLANDO REGIONAL HEALTHCARE SYSTEM, INC., Intervenor. / FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioners filed on March 13, 2006. On April 12, 2006, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On August 14, 2006, the Petitioners filed a Notice of Voluntary Dismissal, stating that the parties had resolved the dispute. On August 16, 2006, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, 205 IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioners’ Petition is dismissed with prejudice and the Agency’s September 8, 2005 Determination is hereby upheld. Unless they have already done so, Petitioners shall submit the correct reimbursement amount as stated in the Agency’s September 8, 2005 Determination to Orlando Regional Healthcare System, Inc. within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Donna Reynolds, 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 LY day of bout , 2008, in Tallahassee, Florida. Pycteke ~— AGENCY FOR HEALTH CARE ADMINISTRATION 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 /§ day of Abre (__, 2008. COPIES. FURNISHED TO: Honorable Barbara J. Staros Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Nathan M. Rymer, Esquire Rymer, Moore, Jackson & Echols, 2801 Post Oak Boulevard, Suite 250 Houston, Texas 77056 Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Donald M. Henderson, Esquire Mateer & Harbert, P.A. Post Office Box 2854 Orlando, Florida 32801 Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 : Tallahassee, Florida 32308 (850) 922-5873

Docket for Case No: 06-001275