FILED STATE OF FLORIDA . A AGENCY FOR HEALTH GARE ADMINISTRATION AGENCY CLERK : 51 5 V's PHARMACY, INC., 201 APR 19 AF eB, 5 ED : Petitioner, . — an vs. , CASE NO. 06-3492MPI- mB C.1. NO. 06-4344-000 25.) ¢3 AGENCY FOR HEALTH CARE JUDGE ERROLH.POWELL, 7 ~ ADMINISTRATION, coe *, Respondent RENDITION NO.: AHCA<*OROt S-MDO / 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. DONE and ORDERED on this the /@_ day of LED , 2007, in Tallahassee, Florida. joc Cc. te. Tes 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 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: Jeffries H. Duvall, Esquire Agency for Health Care Administration (Interoffice Mail) Jose M. Herrera, Esq. Jose M. Herrera, P.A. 1401 Ponce de Leon Blvd., Suite 200 Coral Gables, 33134 (U.S. Mail) The Honorable Errol H. Powell Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399 (U.S. Mail) Linda Keen, Inspector General Agency for Health Care Administration (Interoffice Mail) Tim Byrnes, Bureau Chief, MPI Agency for Health Care Administration (Interoffice Mail) Finance & Accounting Agency for Health Care Administration (interoffice Mail) CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail and/or Interoffice Mail on this the /Pday of Are? , 2007. Richard Shoop, Esquire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 Tel: (850) 922-5873 Fax: (850) 921-0158 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 5 V’s PHARMACY, INC., Petitioner, vs. CASE NO. 06-3492MPI CI. NO. 06-4344-000 AGENCY FOR HEALTH CARE Judge Errol H. Powell ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and 5 V’s PHARMACY, INC. (“PROVIDER”), by and through the undersigned, hereby stipulates and agrees as follows: 1. 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. 0254983-00) in the State of Florida, 3. In its final agency audit report dated July 14, 2006, AHCA notified PROVIDER that a review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $295,893.24. In response to the audit letter dated July 14, 2006, 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 $280,164.62 plus a $5,000.00 fine. The PROVIDER was also sanctioned with the requirement of a Corrective Action Plan in the form of an acknowledgement statement. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (A) ®) (C) @) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. PROVIDER agrees to make a single payment of forty-five thousand one hundred sixty-four dollars and sixty-two cents ($45,164.62) including a $5,000 fine, within thirty (30) days of the issuance of the Final Order. The balance of $240,000.00 shall be paid in 12 monthly installments. Such indebtedness shall incur interest at the statutory rate as set forth in Section 409.913, Florida Statutes. Payment of the above shail constitute full and complete settlement of all claims in this matter. 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 audit referenced as C.1. No. 06-4344-000. 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 in this case. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 6. 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. 7. 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. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. Each party shall bear its own attorneys’ fees and costs, if any, except as set forth herein. 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. 11. 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. 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 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 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 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. 15. 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. 16. 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. 17. | This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpatt. 20. PROVIDER further acknowledges that: a) 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. b) Pursuant to Section 409.913(7)(£), Florida Statutes, a provider has an obligation to ensure that claims for payment under the Medicaid program are documented by records made at the time the goods or services were provided. The Agency is authorized under Section 409.913, Florida Statutes to require repayment for goods or services that are not so documented. 5 V’s Pharmacy i llemel Printed Representative’s Name BY: Lulonek ture) 2007 Dated: > FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Craig H. Smith General Counsel Kr Abon~ Kim Kellum Chief Medicaid Counsel Dated: FAG , 2007 Dated: 2007 Dated: 3-2 2007 Dated: —1{1_ 2007

Docket for Case No: 06-003492MPI