pa FI STATE OF FLORIDA | 1 fe D ITED AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY CLERK STATE OF FLORIDA, AGENCY FOR 2 AUG - 1 A Hh IT MU Ay 02. HEALTH CARE ADMINISTRATION “VISION OF Petiti ADMINISTRATIVE etitioner, HEARINGS vs. Case No. _07-1161MPI Provider No. 950845700 MODERN MEDICAL PRODUCTS, CI. No. 04-2286-000 RENDITION NO.: AHCA*@'1-O4 (1-S-MDO Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement, which is attached and incorporated by reference. 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 S _ day of dy , 2007, in Tallahassee, Florida. pK Cake Cc. as De 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: Sandra Short Modern Medical Products 2412 Lakeland Hills Blvd. Lakeland, Florida 33805 (U.S. Mail) Tracie L Wilks, Assistant General Counsel Agency for Health Care Administration (Interoffice) Linda Keen, Inspector General Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice) Tim Bymes, Chief Medicaid Program Integrity (Interoffice) Finance & Accounting (Interoffice) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was served to the above named addresses by U.S. Mail this //*_ day of Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 May-11-07 02:10P 863-680-1870 P.O1 620d RECEIVED | STATE OF FLORIDA 1 DIVISION OF ADMINISTRATIVE HEARINGS | GENERAL COUNSE! MAY 112007 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Agency for Health Care Administration Petitioner, ve. CASE NO. 07-1161MPI JUDGE R. BRUCE MCKIBBEN MODERN MEDICAL PRODUCTS, Respondcat. oe —____-__—_! SETTLEMENT AGREEMENT The STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and MODERN MEDICAL PRODUCTS (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. The parties enter into this agreement for the purpose of memomializing the resolution to this matter. 2. , MODERN MEDICAL PRODUCTS is a Medicaid provider in the State of Florida, provider number 950845700, and was a provider during the audit period. 3. In its Final Agency Audit Report dated November 23, 2005, AHCA notified MODERN MEDICAL PRODUCTS that review of Medicaid claims performed by the Office of Medicaid Program Integrity (MPI), of the AHCA Inspector General, indicated that certain claims, in whole or in part, were inappropriately paid by Medicaid. The Agency sought repayment of this overpayment, in the amount of fiftccn thousand, one hundred fifty-four dollars and twenty-two cents ($15,154.22), plus a fine of one thousand, five hundred dollars ($1,500.00) for violation of Rule 59G-9.070, Florida Agency for Realth Core Adniniscrac.on v. Negern wadics] Producta Cane Muser OF Vievmst . Secelemunt Agveenenc Onge + of & Ocal N89 ¢98 << LE 0-226-058 S33 ‘SHIM aes s 62-91 O1-SO-LNN May-11-07 02:10P 863-680-1870 as to facts and law, so thal no misunderstanding or misinformation shall be a ground for Tesciasion hereof. 15. MODERN MEDICAL PRODUCTS expressly waives in this maner its nght 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. MODERN MEDICAL PRODUCTS 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 adminictrative proceeding, circuit or federal court action or any appeal. 16 This Agreement is and shal] 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 chall 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, representatives and trustees. 19. 20. 6/94 All times stated herein are of the essence of this Agreement. This Agrecment shall be in full force and effect upon execution by the respective partes in counterpart. Agency for Health Care AOminiatsacaun v. Modern Medical Pouducte Cane tuaber AV-L163"DE . Seceloment Mteement Page $ of 6 Ozgt 099 Ege << L£069°226-0S2 bs3 ‘sau ares. O€-91 O1-S0°-20UC *fay-11-07 02:10P 863-680-1870 P.O3 Vv jon Plan — Acknow it t A “corrective action plan” is the process or plan by which thc 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-cornpliance 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 staternent is duc to Medicaid Program Integrity within 30 days of the issuance of this FAR. Please sign the enclosed statement and return it to: Patricia S. Humphries 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 include monetary fines, suspension, or termination from the Medicaid program. Correcnve action plan -- Acknowledgement Statenient Final Agency Audit Report dated Novernber 23, 2005 Moder Medical Products C.1. 04-2286-000 Odet 089 £928 << LDED-2ZE-USB bsg saiaa 10041 OC-yt O1-SO-2002 66d May-11-07 O2:10P 863-680-1870 P.0o4 Administrative Code; and a corrective action plan in the form of a Provider Acknowledgement Statement. In response to the audit report dated November 23, 2005, MODERN MEDICAL PRODUCTS sent a letter to the Agency requesting an Administrative Hearing. 4. Subsequent to the original audit that took place in this matter and after further documentation review, AHCA determined that the overpayment amount should be adjusted to eight thousand, eight hundred fifty-three dollars and ninety-two cents ($8,853.92). Additionally, a sanction in the amount of one thousand dollars ($1,000.00) was assessed pursuant to Rule 59G-9.070, Florida Administrative Code; plus one— hundred forty-six dollars and eight cents ($146.08) in costs. The total amount due is ten thousand dollars ($10,000.00). MODERN MEDICAL PRODUCTS must also submit a corrective action plan in the form of a Provider Acknowledgement Statement. 5. In order to resolve this matter without further administrative proceedings, MODERN MEDICAL PRODUCTS and AHCA expressly agree as follows: (1) AHCA agrees to accept the payment set forth herein in settlemeat of the overpayment issues arising from the MPI review. (2) Within thirty (30) days of the date of execution of a Final Order adopting this Scttlemcnt Agreement, MODERN MEDICAL PRODUCTS agrees to make a down payment of two thousand dollars ($2,000.00). The balance of the overpayment, six thousand, eight hundred fifty-three dollars and ninety-two cents ($6,853.92); plus a sanction in the amount of one thousand dollars (31,000.00); plus one hundred forty-six dollars and eight cents Agency Cor HeBIEA Care aGuimorrarian v Madern Medical Products Cane Mumbew OF-LLC1MPT - Jetcloment Agreencoc Page 3 of & Ozet 099 €98 << £pey-2Z26-058 bs3 ‘smn a19e 41 6791 O1-SO-200 May-11-07 02:11P b/d 7. 863-680-1870 ($146.08) in costs shall be paid to AHCA over a period of six (6) months at 10% interest on the balance during the payment period to settle all claims in the proceedings of C.]. No. 04-2286-000. (3) MODERN MEDICAL PRODUCTS and AHCA agree that such payments a8 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.]. No. 04-2286-000. (4) | MODERN MEDICAL PRODUCTS 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. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Flonda 32317-3749 Overpayments owed to the agency bear interest at the rate of 10 percent per year from the date of determination of thc overpayment by the agency, and payment arrangements must be made at the conclusion of legal proceedings, pursuant to section 409.913 (25)(c), Florida Statutes. 8. MODERN MEDICAL PRODUCTS agrees that faiture to pay any monies due and owing under the terms of this Agreement shall constitute MODERN MEDICAL PRODUCTS: 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 MODERN MEDICAL PRODUCTS for any Medicaid claims, Agency (oe Health Care Ad@mnistcacion Vv. Modern Hedicek Producto Sese womber 97-11G\MPL - Fecclement Agreement Bage ) of 6 ocgi oage3a «= <« LE D-226°058 bsg Sanaa 28 2L 62°91 01-30-2000 May-11-07 o02:11P 863-680-1870 9. AHCA teserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and al) other applicable rules and regulations. 10. This settlement does not constitute an admission of wrongdoing or crror by either party with respect to this case or any other matter. 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 siall 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, Flonda. 13. This Agreement constitutes the entire agreement between MODERN MEDICAL PRODUCTS and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes uny prior discussions, agrocments or understandings; there are no promises, representations or egreements between MODERN MEDICAL PRODUCTS and AHCA other than as set forth herein. No modification or waiver of any provision shal) be valid unless a written amendment to the Agreement 1s 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 facis and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions agency lor Neelen Core administyrecion v. Modern Medical Products Cage Bummer 07 uiciept = Zectlemint Agree bage tal 6 ozo 089 E98 << £VE°7Z6 OSB bsg Sy aes, OE SL ML-SO-L00¢ May-11-07 O02:11P 863-680-1870 Datea: 5-1), 2007 (Print uame) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Bldg. 3, Mail Stop #3 Tallahassee, FL 32308-5403 Chanda) Neer __._—dDated: 2007 Linda Keen Inspector General Dated: Jae 2007 Krom Ke Murer wea: lo ff Kim Kellum —— » ws lof —__ 2007 Chief Medicaid Counsel ney yht be) Dated: fis. f 2007 Tracie Wilks Assistant General Counsel agency for Health Care aAdmindacration vo Modera Medical Products Case Mumbar O7.L1CiMP] - Goctlomone Agreement Page ¢ of ¢ aA manera eel el aed Seal hey -eunas arvase nea tune inet ~May-11-07 02:12P 863-680-1870 P.10 PROVIDER ACKNOWLEDGEMENT STATEMENT I Savoen Siraas— , on behalf of Modem Medical Products, a Medicaid provider operating under provider number 9508457 00, do hereby acknowledge the obligation of Modern Medical Products to adhere to state and federal Medicaid laws, rules, provisions, handbooks. and policies. Additionally, Modern Medical Products acknowledges that Medicaid policy, as referenced in 409.913, Florida Statutes, The Medicaid Provider Agrecment, or the DME/Medical Supply Services Coverage and Limitations Handbook, Covered Services, Limstations, and Exclusions, Service Requirements, effective January 2000, states or requires the following: 1. A Medicaid provider agrees to comply with local, state, and federal laws, as well as rules, regulations, and statements of policy applicable to the Medicaid program, including the Medicaid Provider Handbooks issued by AHCA. 2. A Mcdicaid provider must retain medical, professional, financial aad business records pertaining to goods and services furnished to Medicaid recipients for a period of at least five (5) years after the date of furnishing the goods or services. 3. A Medicaid provider must provide all Medicaid related records within the time frame established by the Agency. 4. 4 A Medicaid provider must, as referred to in the Final Audit Report for C.I. No. 04-2286-000- a. Abide by the Medicaid allowed maximum rental limite; b. Abide by the limits for phototherapy application and medical necessity. ~~ By. (title) Return completed acknowledgement statement to Medicaid Program Integrity. Corrective acaon plan -- Acknowledgement Statement Final Agency Audit Report dated November 23, 2005 Modern Medical Products C.J. 04-2286-000 ce Arar Aan eas ee mr meIzE LAr how ‘evtias anon team nn ener nr?

Docket for Case No: 07-001161MPI