Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: SOUTH POINT PHARMACY
Judges: CLAUDE B. ARRINGTON
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Apr. 28, 2006
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, June 26, 2006.
Latest Update: Dec. 25, 2024
STATE OF FLORIDA __
DIVISION OF ADMINISTRATIVE HEARINGS
SOUTH POINT PHARMACY
CORPORATION,
Petitioner,
CASE NO: 06-1545MPI
v. C.I. No. 06-4164-000
JUDGE: CLAUDE ARRINGTON
STATE OF FLORIDA, AGENCY F ‘OR Medicaid Provider No.: 026775900
HEALTH CARE ADMINISTRATION,
Respondent,
/
;
FINAL ORDER
The parties resolved all disputed issues and executed a Settlement Agreement, which is
incorporated by reference, 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 Levy Of PEW? |, 2006, in
Tallahassee, Florida,
of? oe Chrfsta Calamas, Secretary
Agency for Health Care Administration
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:
Nelson Suarez
South Point Pharmacy Corporation
1835 West Flagler Street, Suite 204
Miami, Florida 33135
John G. Van Laningham
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, FL 32399
Anthony L. Conticello, Esquire
Agency for Health Care Administration
(Interoffice Mail)
James D. Boyd, Inspector General
Agency for Health Care Administration
(Interoffice Mail)
Timothy Byrnes, Bureau Chief
Medicaid Program Integrity
Agency for Health Care Administration
(Interoffice Mail)
Bureau of Finance and Accounting
Agency for Health Care Administration
(Interoffice Mail)
CERTIFICATE OF SERVICE
— LE 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 /Z* tayo
ae
hoop, Agency
Agency for Health Care Administration
2727 Mahan Drive, Building #3
Tallahassee, Florida 32308-5403
(850) 922-5873
STATE OF FLORIDA iy v4 EO
DIVISION OF ADMINISTRATIVE HEARINGS Lp AD.
2
SOUTH POINT PHARMACY Wien 4y,
POKES “O,
«a Sapa
Petitioner, ae; ye :
vs. CASE NO. 06-1545MPI
JUDGE: Claude B. Arrington
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA” or “the Agency”), and South Point Pharmacy, (“Provider”), by and through the
undersigned, hereby stipulate and agree as follows:
1. This Agreement is entered into between the parties for the purpose of avoiding the
costs and burdens of litigation, and neither party concedes the other’s position.
2. Provider has the following Florida Medicaid Provider 0267759 00.
3. Inits Final Agency Audit Report C.I. No. 06-4164-000 dated March 28, 2006
(hereafter, “Audit Report”), AHCA notified Provider that review of Medicaid claims
performed by Medicaid Program Integrity (MPI) for the period December 1, 2004, to
November 30, 2005 (the “Audit Period”), indicated that, in its opinion, some
Medicaid claims in whole or in part were not covered by Medicaid. The Agency
initially sought overpayment in the amount of $4,383.66, In response, Provider filed
a petition for a formal administrative hearing and the matter was sent to the Division
of Administrative Hearings for a formal hearing and was assigned Case No: 06-
1545MPI.
. The matter was remanded to the Agency by the Division of Administrative Hearings
for the purposes of allowing the parties time to resolve the overpayment issues. The
Agency reviewed the additional documentation and considered arguments of
Petitioner, which resulted in an adjusted overpayment amount of $1,275.06 (the
“Adjusted Overpayment”), Petitioner agrees to pay the entire Adjusted Overpayment
plus an additional $1,000.00 in costs for a total settlement amount of $2,275.06 (the
“Total Settlement Amount”). Provider also agrees as to complete the Provider
Acknowledgement Statement attached to the FAAR and file it with AHCA within
thirty (30) days of the date of the final order. A true and correct copy of the Provider
Acknowledgement Statement is attached and incorporated into this Settlement
Agreement.
- In order to resolve this matter without resort to further administrative proceedings,
Provider and AHCA expressly agree as follows:
(A). AHCA shall accept full payment set forth herein in settlement of all
overpayment issues arising from the MPI review, including AHCA’s investigative
costs.
(B) Within thirty (30) days of receipt of a Final Order incorporating this
Settlement Agreement, Provider agrees to pay to AHCA the Total Settlement
Amount as set forth in paragraph no. 4 ($2,275.06).
tu
(C) Provider and AHCA agree that full payment as set forth above will resolve
and settle this case completely and telease both parties from all liabilities arising
from the Audit Report.
(D) 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
Report. |
(E) This Settlement Agreement does not constitute an admission of guilt,
wrongdoing or error by either party with respect to this case or any other matter.
(F) Provider agrees to execute the Provider Acknowledgement Statement and
file it with AHCA within 30 days of the date of the Final Order,
6. 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 settlement agreement, shall
reference both the Provider Number, and the C.I. Number.
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. The parties agree to bear their own attorney’s fees and costs, if any.
10. 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.
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 Settlement Agreement
to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel a final
hearing, if one is pending, and have the Division of Administrative Hearings relinquish
jurisdiction back to the Agency.
11. This Agreement shail 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.
12. 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.
13. This is an Agreement of settlement and compromise, made in Ttecognition that the
parties may have different or incorrect understandings, information and contentions, as to facts
and Jaw, 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.
14. PROVIDER expressly waives in this matter its tight 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 the Agency should issue a Final Order which is consistent with the terms of
this settlement, that adopts this agreement and closes this matter.
15. 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.L. No. 06-4164-000, AHCA?’s
actions herein, including, but not limited to, any claims that were or may be asserted i in any
federal or state court or administrative forum, including any claims arising out of this agreement,
by or on behalf of Facility.
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
Teason, such provision shall be effective to the extent not so prohibited, and such prohibition
shall not affect any other provision of this 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.
PETITIONER:
SOUTH POINT PHARMACY
Dated: A-'S- 2006 , 2006.
By: Y1.S
Nelson Suarez
irs: Sw fo
President
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
_Zretisl Dated:
By S D. BOYD
Inspector General
Ak OZ OY ae Dated:
WILLIAM H. ROBERTS
Acting Gene: ‘ounsel
L. CONTICELLO
Assistant General Counsel
fee
Wet
, 2006.
_, 2006.
Dated:
2006.
lO/ 26
South Point Pharmacy Corporation
PROVIDER ACKNOWLEDGEMENT STATEMENT
X—— EE EEE BI GEMENT STATEMENT
I NELSON suaRnes_ , on behalf of South Point Pharmacy
(insert printed full name here)
Corporation, a Medicaid provider operating under provider number 026775 900, do
hereby acknowledge the obligation of South Point Pharmacy Corporation to
adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. :
Additionally, South Point Pharmacy Corporation acknowledges that Medicaid policy
requires:
(1) A Medicaid provider must retain medical, professional, financial, and business
records pertaining to goods and services furnished to Medicaid recipients for a period
of at least five (5) years from the dates of service, in accordance with Section
409.913 (9), Florida Statutes (F.S.), the Medicaid Provider Agreement, and the July
2001 Prescribed Drug Services Coverage, Limitations and Reimbursement Handbook
page 2-17,
(2) A Medicaid provider must demonstrate the availability of sufficient quantities of
goods during a specific audit or review period to support the provider's billings to the
Medicaid program, in accordance with Section 409.913 (15)(n), F.S. and the July
2001 Prescribed Drug Services Coverage, Limitations and Reimbursement
Handbook, page 2-18. .
By: V1 S AN Date: 9-5- OG
(signature)
POES st
(title)
Return completed acknowledgement statement to Medicaid Program Integrity.
Corrective Action Plan — Acknowledgement Statement
Final Agency Audit Report dated March 28, 2006
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Docket for Case No: 06-001545MPI
Issue Date |
Proceedings |
Dec. 13, 2006 |
Final Order filed.
|
Jun. 26, 2006 |
Order Closing File. CASE CLOSED.
|
Jun. 22, 2006 |
Agreed Notice of Settlement filed.
|
May 18, 2006 |
Order of Pre-hearing Instructions.
|
May 18, 2006 |
Notice of Hearing (hearing set for July 11 through 13, 2006; 9:00 a.m.; Tallahassee, FL).
|
May 16, 2006 |
Unilateral Response to Initial Order filed.
|
May 01, 2006 |
Initial Order.
|
Apr. 28, 2006 |
Final Audit Report filed.
|
Apr. 28, 2006 |
Request for Formal Hearing filed.
|
Apr. 28, 2006 |
Notice (of Agency referral) filed.
|