STATE OF FLORIDA AGENCY CLERK DIVISION OF ADMINISTRATIVE HEARINGS 2008 FEB 12 P 230 BAPTIST|HOSPITAL, INC. d/b/a BAPTIST HOSPITAL, Petitioner, VS. CASE NO. 06-2139MPI 07-1679MPI MPI CASE NO. 04-2351-000 STATE OF FLORIDA, 05-3912-000 AGENCY FOR HEALTH CARE RENDITION NO.: AHCA-0B- OA -s- ADMINI$TRATION Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties ar¢ 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 ft day of Tb , 2007, in Tallahassee, Florida. ANDREW C. - Lae M.D., 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 oA tcheo Re 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: Daniel W.|Lake, Esquire Agency for Health Care Administration (nteroffice Mail) Willis F. Melvin, Esquire Agency for Health Care Administration (Interoffice Mail) Jonathan LL. Rue, Esquire Parker, Hudson, Rainer & Dobbs, LLP 1500 Marquis Two Tower 285 Peachtree Center Avenue Northeast Atlanta, ceo 3003 (U.S. Mail) Suzanne ¥. Hoold Administtative Law Judge Division of Administrative Hearings The DeSato Building 1230 Apallachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Debbie Lynn, Medicaid Program Integrity Finance and Accounting CERTIFICATE OF SERVICE LHEREBY CERTIFY that a true and ccrrect copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the iz day of az - 2008 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 DIVISION OF ADMINISTRATIVE HEARINGS BAPTIST HOSPITAL, INC., d/b/a BAPTIST HOSPITAL, Case No.: 06-2139MPI Case No.: 07-1679MPI Petitioner, vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA’ or “the Agency”), and BAPTIST HOSPITAL, INC., d/b/a BAPTIST HOSPITAL (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: _ This Agreement is entered into for the purpose of memorializing the final resolution of the matters set forth in this Agreement. 2. PROVIDER is a Medicaid provider (Medicaid Provider No. 010074900) in the State of Florida. 3. In its final audit report (FAR) dated May 10, 2006 for the case referenced as CI. No. 04-2851-000, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid) Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not povered by Medicaid. The Agency sought overpayment in the amount of $375,889.68. In response to the FAR, PROVIDER filed a petition for a formal administrative hearing. Subsequently and after additional information was provided, AHCA reviewed the disputed claims and determined the outstanding amount of overpayment should be adjusted to $217,613 625462_1 17 with a fine of $1,000.00, and $7,500.00 in legal (attomney’s fees, court reporting fees, travel expenses, consulting fees, etc.), investigative, and expert witness costs for a total balance of $226,113.17. 4. In its final audit report (FAR) dated March 16, 2007 for the case referenced as C.I. No. ¢5-3912-000, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid] Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not kovered by Medicaid. The Agency sought overpayment in the amount of $774,178.34. In response to the FAR, PROVIDER filed a petition for a formal administrative hearing. Subsequently and after additional information was provided, AHCA reviewed the disputed claims ahd determined the outstanding amount of overpayment should be adjusted to $183,938113 with a fine of $1,000.00, and $7,500.00 in legal (attorney’s fees, court reporting fees, travel expenses, consulting fees, etc.), investigative, and expert witness costs for a total balance of $192,438.13. 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 reviews. (2) PROVIDER agrees to make a single payment of four hundred eighteen thousand five hundred fifty-one dollars and thirty cents ($418,551.30), in full and complete settlement of all claims in this matter, within 30 days of issuance of a Final Order adopting this agreement. This amount will be credited as $401,551.30 to remedy the adjusted overpayments; $2,000.00 to remedy the fines; and, the remainder ($15,000.00) will be credited toward AHCA’s investigation, legal and expert witness expenses. 625462_1 (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 audits referenced as C.L No. 04-2351-000 and C.I. No. 05-3912-000. (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 audits in this case. 6. PROVIDER has executed a Corrective Action Plan and an Acknowledgment Statement, which is attached hereto and incorporated fully herein. 7. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 8. 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 ndgtice, 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. 9. 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. 10. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. ll]. Each party shall bear its own attorneys’ fees and costs, if any, except as set forth herein. 13. 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. 625462_1 ~ 3 13. 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. 14. This Agreement constitutes the entire agreement between PROVIDER and the AHCA, ihcluding anyone acting for, associated with or employed by them, concerning all matters dnd supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between PROVIDER and the AHCA other than as set forth herkin. 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. 15. 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 incorrecthess of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 16. | 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 rules 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 right to any administrative proceeding, circuit or federal court action or any appeal. 17. 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. 625462_1 18, 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. 19. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 20. All times stated herein are of the essence of this Agreement. 21, This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. 24. In the event either party breaches this Agreement, the costs and attorney fees incurred| by the non-breaching party associated with enforcement or collection activity pertaining to this Agreement shall be paid by the party breaching this Agreement to the non- breaching party. BAPTIST HOSPITAL, INC., d/b/a BAPTIST HOSPITAL 6 Auton Terra Dated: //- /¥ —2007_, 2007 Printed Representative’s Name a (signature) bas 6254621 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Malan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: a-H , 200% Linda n Inspector |General Craig H Dated: te. 209% s? General h vel 4K 0 Dre Dated: 1 / {5 200f im Kell Chief Medicaid Counsel UI, ?. elvin, Jr. General Counsel [ Dated: Nii bt 22 , 2007 ‘ Lf EEF so cS , 208 Willis F. Assistant| Gil Assistant|Geng 625462_1 Corrective Action Plan — Acknowledgement Statement A “corrective action plan” is the process or plan by which the provider will ensure future compliante with state and federal Medicaid laws, rules, provisions, handbooks, and policies. For purposes $f this matter, the sanction of a corrective action plan shal! 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 ” w 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 atknowledgement statement is due to Medicaid Program Integrity within 30 days of the issuarice of this FAR. Please sign the enclosed statement and return it to: Debbie Lynn Age ncy for Health Care Administration Medicaid Program Integrity 2727 Mahan Drive, Mail Stop # 6 Tallahassee, FL 32308-5403 Pho ne (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) 625462_1 program. PROVIDER ACKNOWLEDGEMENT STATEMENT , on behalf of Baptist Hospital, Inc., I + bndreo (insert printed full name here) a Medicaid provider operating under provider number 010074900, do hereby acknowledge the obligation of Baptist Hospital, Inc. to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Baptist Hospital, Inc. acknowledges that Florida Medicaid Hospital Coverage and Limitations, dated May 2000, policy requires: Service Requirements 625482_1 Medicaid reimburses for services that are determined medically necessary, do not duplicate another provider’s service, and are: individualized, specific, consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient’s needs; not experimental or investigational; reflective of the level of services that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide; furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider. The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itself, make such cate, goods or services medically necessary or a covered service. The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itself, make such care, goods or services medically necessary or a covered service. By: EG eces ——— Date: 46-14% - 2007 (signature) fer Me (title) a Return completed acknowledgement statement to Medicaid Program Integrity. 625462_1

Docket for Case No: 06-002139MPI