STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 48 CITY OF PENSACOLA, DEVI $ Petitioner, DOAH CASE NO. 06-4670 ¢ HEARIN AHCA NO. 2006009346 v. DETERMINATION NO. 20060815-001 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER THIS CAUSE concerns an Amended Petition for Administrative Hearing (“Petition”) that the Petitioner filed on November 13, 2006. On November 17, 2006, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On February 9, 2007, the Petitioner filed a Notice of Voluntary Dismissal with Prejudice, stating that the parties had resolved the dispute. On February 12, 2007, the ALJ assigned to the case entered an Order Closing File, relinquishing jurisdiction back to the Agency. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petitioner’s Petition is dismissed with prejudice and the Agency’s September 5, 2006, Determination is hereby upheld. Unless they have already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s September 5, 2006, Determination to West Florida Hospital within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Ms. Twan Jackson, Workers’ Compensation Medical Services Unit, c/o Department of Financial Services, 200’ East Gaines Street, Tallahassee, Florida 32399-4232. Petitioner shall govern itself accordingly. DONE and ORDERED this 02 Thea of a rene , , 2008, in Tallahassee, Florida. AGENCY FOR HEALTH CARE ADMINISTRATION NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE 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 THE RENDITION OF THE ORDER TO BE REVIEWED. ; CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been ts furnished by U.S. or interoffice mail to the persons named below on this , tO day of yre , 2008. ee RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: P. Michael Ruff Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Mari H. McCuily, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Stephen A. Ecenia, Esquire Rutledge, Ecenia, Purnell & Hoffman, P.A. 215 South Monroe Street, Suite 420 Post Office Box 551 Tallahassee, Florida 32302-0551 Jan Mills Facilities Intake Annemarie C. Craft, Esquire Stiles, Taylor & Grace Post Office Box 1140 Tallahassee, Florida 32302 Elizabeth Dudek Health Quality Assurance West Florida Hospital c/o West Florida Regional Medical Center, Inc. 8383 North Davis Highway Pensacola, Florida 32514 Broadspire Services, Inc. P.O. Box 25102 Lehigh Valley, Pennsylvania 18002-5102 FairPay Solutions 14295 Midway Road Suite 300 Addison, Texas 75001

Docket for Case No: 06-004670