STATE OF FLORIDA paces AGENCY FOR HEALTH CARE ADMINISTRATION ti eee 21 -STATE OF FLORIDA, . B AGENCY FOR HEALTH CARE 8c g “A ADMINISTRATION, ASe 2 = Pee SY . Bag ey Petitioner, g2= 0 ne OBg, oS vs. CASE NO. 06-3682MPfn . PROVIDER NO. 088087600 © FLAGLER COUNTY AMBULANCE AUDIT C.I. NO. 06-4507-000 SERVICE, RENDITION NO.: AHCA-06-24.54 -s-mpo Respondent. / 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 _/ P day of DEL BHO _, 2006, ‘jn Tallahassee, Florida. paseo 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice’ Mail) Mauricio Chavez Director of Operations Per-Se’ Technologies for Flagler County Ambulance Service 7955 NW 12 Street, Suite 100 Doral, Florida 33126 (U.S. Mail) P. Michael Ruff Administrative Law Judge Division of Administrative Hearings * The DeSoto Building. 1230 Apalachee Parkway Tallahassee, Florida 32399-3060: Tim Byrnes, Chief, Medicaid Program Integrity Robin Satchell, 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 theZ7” day of nen ber” _, 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 WOU-27-28@6 12:26 FROM:FLAGLER COUNTY EMERG 386-45 ¢~ (abs DL LET I ated te net c f STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. CASE NO, 06-3682MPI FLAGLER COUNTY AMBULANCE SERVICE, Respondent. / a ead SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and. Flagler County Ambulance Service (“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 resolution to this matter. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 088087600 and was a provider during the audit period. " 3. In its Final Agency Audit Report (final agency action) dated August 3, 2006, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI), 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 $2,437.13. In response to the August 3, 2006 audit letter, PROVIDER filed a petition for formal administrative hearing. It was assigned DOAH Case No. 06-3682, Flagler County Ambulance Service Settlement Agreement 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 yesult of the additional review, AHCA determined the overpayment should be adjusted to $401.01. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA agree as follows: (1) (2) (3) AHICA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of entry of the final order, PROVIDER agrees to make a lump sum payment of four hundred one dollars and one cent ($401.01) in overpayment, a five hundred dollar ($500.00) fine and one hundred fifty dollars ($150.00) in investigative costs for a total of one thousand fifty one dollars and one cent ($1,051.01). This fully and completely settles all claims in these proceedings before the Division of Administrative Hearings (DOAH Case No. 06-3682). 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.I. 06- 4507-000. . HOU-27?-2886 12:26 FROM:FLAGLER COUNTY EMERG sBB-Saf- fos FU eh EG Lk eat ed ce weet se Flagler County Ambulance Service Settlement Agreement (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 Agrecment shal] constitute PROVIDER'S authorization for the Agency, without further notiec, 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 Progratn, and all other applicable rules and regulations. 9. PROVIDER acknowledges their obligation to adhere to stale and. federal Medicaid laws, rules, provisions, handbooks and policies. ot 10. . PROVIDER agrees to follow the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement, and agrees that Medicaid does not pay for services that do not meet these guidelines. 11. Flagler County Ambulance Service, a Medicaid provider operating under provider number 0880876 00, does hereby acknowledge the obligation of Flagler County Ambulance. sit Service to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Flagler County Ambulance Service acknowledges that Medicaid policy requi : providers o° follow the guidelines set forth in the. applicable Rules and Medicaid fee schedules, ~ NOU-27-2886 12:27 FROM:FLAGLER COUNTY EER obsot rn? Tee ee eee Flagler County Ambulance Service Settlement Agreement as promulgated in the Medicaid policy handbooks, billing bulletins, and the Medicaid provider agreement. Medicaid cannot pay for services that do not meet these guidelines. 12, This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 13. Each party shall bear its own attorneys’ fees and costs, if any. The Respondent shall reimburse, as part of this settlement, $500.00 in Agency costs of action. This amount is | included in the calculations and demand of paragraph 5(2).) 14, ‘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. 15, 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 L 16. This Agreement constitutes the entire agreement between PROVIDER and the County, Florida. AJICA, 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 hercin. 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. 17. 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 jncorreciness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hercof. . NOU-2?-e@b Teter PROM Le NS Flagler County Ambulance Service Settlement Agreement 18. PROVIDER expressly waives in 1 this qatter.its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of Jaw by the Agency, and all further and other proceedings to which it may be entitled by law or mules 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 tight to any administrative proceeding, circuit or federal court action or any rf appeal. 19. This Agreement is and shall be deemed jointly drafted and written by all partics to Bye it and shall not be construed or interpreted against the party originating or preparing it. he 20. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shal] be effective to the extent not so prohibited, and such probibition - shall not affect any other provision of this Agreement. ” : 21. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. . . : 22, Ali times stated herein are of the essence of this Agreement. 4 - 23. This Agreement shall be in full force and effect upon execution by the respective cor parties in counterpart. : BOARD OF COUNTY COMMISSIONERS FLAGLER COUNTY, FLORIDA: ; ATTEST: . 6 ' Miya. be terim County Attomey ) 1of31 {2 , NOV-27-28@86 teser FRU Pree eee eee OO Flagler County Ambulance Service r Settlement Agreement AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: /Z-/?- , 2006 es D. Boyd ; Inspector General Zable pated: PHS & _,2006 (William Roberts Acting General Counsel aA— Dated: [f ~zZ ra _, 2006

Docket for Case No: 06-003682MPI