STATE OF FLORIDA ; _— AGENCY FOR HEALTH CARE ADMINISTRATION ..;. Pet AS STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, eon ; Exbs 0, A vs. CASE NO. 06-2413MPI Oe aa 25 PROVIDER NO. 371741100 CARRIERZAND ASSOCIATES, AUDIT C.I. NO. 04-2080- 000 Respondent. } RENDITION NO.: AHCA-06- 0237 &-s5-mpo 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. Dad DONE and ORDERED on this the ~2Y “day of _@cT@ees<. 2006, in Tallahassee, Florida. IY tista Calamas, Secfetary 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 II, Esquire Agency for Health Care Administration (Interoffice Mail) Gregory A. Chaires, Esquire Webster, Chaires & Partners, P.L. Post Office Box 2310 Winter Park, Florida 32790-2310 (U.S. Mail) Ella Jane P. 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 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 day of OctGer_, 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 ' resolution to this matter. STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS ’ 7b OCT 27 AU: 22 » STATE OF FLORIDA, . AGENCY FOR HEALTH CARE sols \3 VE ADMINISTRATION, . ADEN i Sita Petitioner, “vs, CASE NO. 06-2413MPI PROVIDER NO. 371741100 CARRIERE AND ASSOCIATES, Respondent. ; / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR 'HEALTH CARE ADMINISTRATION _ (“AHCA” or “the Agency”), and Carriere and Associates (“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 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 371741100 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated March 14, 2006, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPD, 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 $93,627.01. In response to the March 14, 2006 audit letter, PROVIDER filed a petition for formal administrative hearing. It was assigned DOAH Case No. 06-2413MPI. 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 $44,437.52. 5. | In order to resolve this matter without further administrative proceedings, : PROVIDER and the AHCA agree as follows: q) (2) (3) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising fromm the MPI review. Within thirty days of entry of the final order, PROVIDER agrees to make a lump sum payment of forty four thousand four hundred thirty seven dollars and fifty-two cents ($44,437.52), two thousand dollars ($2,000.00) in investigative costs, plus three thousand dollars ($3000.00) in fines for a total of forty nine thousand four hundred thirty seven dollars and fifty-two cents ($49,437.52). This fully and completely settles all claims in these proceedings before the Division of Administrative Hearings (DOAH Case No. 06-2413MPI). 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.1. 04- 2080-000. (4) PROVIDER agrees, that it will not rebill the Medicaid Program in any manner for claims that were determined not covered by Medicaid, which are 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. With the exception that the Respondent shall reimburse, as part of this settlement, $2,000.00 in Agency costs of action. This amount is included in the calculations and demand of paragraph 5(2).) 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, agregments 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. 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 i 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. 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. j ' 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 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, representativés and trustees. 19. All times stated herein are ef the essence of this Agreement. 20., This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. CARRIERE & ASSOCIATES , are £ a car Dated: , 2006 BY: WzzL74m CARRTERE, fu) (Print name) "ITS: y fi . AGENCY FOR HEALTH CARE | ADMINISTRATION ‘ ' 2727 Mahan Drive, Mail Stop #3 ; Tallahassee, FL 32308-5403 ffeeeted Dated: £0724 , 2006 es D. Boyd Inspector General ay 41 KE: Ct Dated: [b[2->_. 2006 William Roberts Acting Gyneral Counsel L. Williarn Porter IT Assistant General Counsel 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 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 itclude monetary fines, suspension, or termination from the Medicaid program. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated March 14, 2006 C.1. 02-4080-000 PROVIDER ACKNOWLEDGEMENT STATEMENT 1 Wram C4eRIERE , 00 __, on behalf of Carriere & Associates, : (insert printed full name here) a Medicaid provider operating under provider number 3717411-00, do hereby acknowledge the obligation of Carriere & Associates to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Carriere & Associates acknowledges that Medicaid policy requires: ‘1) Medicaid policy defines the varying levels of care and expertise required for ‘the evaluation and management procedure codes for office visits. Medicaid uses the Physician’s Current Procedure Terminology (CPT) book, which contains ‘complete descriptions of the standard codes. Medical records must state the necessity for and extent of services provided. The following requirements may ‘vary according to the service rendered: history; physical assessment; chief ‘complaint on each visit; diagnostic test and results; diagnosis; treatment plan, ‘including prescriptions; medications, supplies, scheduling frequency for follow- ‘up or other services; progress reports, treatment rendered; the author of each ‘(medical record) entry must be identified and must authenticate his or her entry by “signature, written initials or computer entry; dates of service; and referrals to other services. 2) The Physician Services Coverage and Limitations Handbook, Chapter 2, states: ' ' Medicaid reimburses for services that are determined to be medically necessary and do not duplicate another provider’s service. In addition, the services must ‘ meet the following criteria: e Be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain; e Be individualized specific, consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs; ‘ * Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational; e Reflect the level of services that cdn be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide; and e Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated March 14, 2006 C.1. 02-4080-000 3) The Physicians Coverage and Limitations Handbook requires that if a physician provider employs or contracts with any health care practitioner (physician, physician assistant,tor advanced registered nurse practitioner) who can enroll as a Medicaid provider and that health care practitioner is treating Medicaid recipients, he or she must enroll as a Medieaid provider. It also requires that two or more Medicaid providers whose practice is incorporated under the same tax identification number must enroll as a Medicaid provider group. In order to receive payment from Medicaid, each member of the group must also enroll as an individual treating provider within the group. 4) Medicaid policy requires ‘that the provider must retain all medical, fiscal, professional, and business records on all services provided to a Medicaid ‘recipient. The records must be accessible; legible and comprehensible. Records “must be retained for a period of at least five years from the date of service, and ‘must state the necessity for and the extent of services provided. These ‘requirements are currently found in the Florida Medicaid Provider General ‘Handbook, dated October 2003. Prior to this time, they were spelled out in the ‘Medicaid Provider Reimbursement Handbook, HCFA-1500 and Child Health Check-Up Reimbursement Handbook. 5) The January 2000 Physician Service’ Coverage and Limitations Handbook -covers Immunization Services. The policy in chapter 2 states that Medicaid reimburses an administration fee to physicians, ARNPs and PAs providing free ‘vaccine through the VFC (Vaccine for Children program) to eligible recipients. ‘The provider must bill with the CPT code assigned to the vaccine. The January 2001 Handbook states that the, provider must bill with the CPT code or W code assigned to the vaccine. 6) The Child Health Check-Up (CHCUP) Coverage and Limitations Handbook, Chapter 2, states that CHCUP providers may only bill for one visit, a sick visit or a Child Health Check Up. If the child is sick, the provider should treat or refer the child for the illness and reschedule the Child Health Check Up. 7) The Medicaid Physician Services Coverage and Limitations Handbook, Chapter Two, states that manual or automated dipstick urine, hemoglobin and hematocrit tests performed as part of a visit are not reimbursed in addition to the visit. The provider cannot bill for them as ‘separate procedures. 8) The Physician’s Coverage and Limitations Handbook states that all services must be done by or under the direct supervision of the physician. Direct supervision means the physician: e Ison the premises wher the services are rendered; and * Reviews, signs, and dates the medical record , Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated March 14, 2006 C.1. 02-4080-000 1 By: . J ios Aelinw ‘Date: of fl 2 Ot) (signaturey fd OW AER (title) Return completed acknowledgement statement to Medicaid Program Integrity. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated March 14, 2006 C.I. 02-4080-000

Docket for Case No: 06-002413MPI