FILED _ ANCA STATE OF FLORIDA AGENCY CLERK AGENCY FOR HEALTH CARE ADMINISTRATION a) Juy -1 A. 8 Ob: STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, 2 ‘ ny vs. CASE NO. 07-1288M | PROVIDER NO. 264606400 Ay NORBERTO FLEITES, M.D., AUDIT NO. 05-2724-000 =) S RENDITION NO.: AHCA oF-CZ4 -S-MDO- 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 _6_ day of hear , 2007, in Tallahassee, Florida. drew C. Agwunobi, 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: Karen Dexter, Esquire Agency for Health Care Administration (Interoffice Mail) Mark Rosen, Esq. Lubell & Rosen, P.A. 100 Southeast Third Avenue, Suite 1600 Fort Lauderdale, Florida 33394 (U.S. Mail) The Honorable Daniel Manry Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Bureau Chief, Medicaid Program Integrity (Interoffice Mail) Linda Keen, Inspector General (Interoffice Mail) Finance and Accounting (Interoffice Mail) 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 Pruay of _< ne , 2007. Richard Shoop, Agency Cler! Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 (850) 922-5873 phone (850) 921-0158 fax STATE OF FLORIDA Cbiestok! fee DIVISION OF ADMINISTRATIVE HEARINGS . NORBERTO FLEITES, M.D. Petitioner, : vs. CASE NO. 07-1288 MPI STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Norberto Fleites, M.D. (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. The two pattiés 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 264606400 and was a provider during the audit period. 3. In its Final Audit Report (final agency action) dated November 21, 2005, 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, has been inappropriately paid by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $37,402.66, a $3000.00 fine for violation of Rule Section 59G- 9.070, and a corrective action plan in the form of a Provider Acknowledgement Statement. In response to the audit letter dated November 21, 2005, PROVIDER filed a petition for a formal Dannivad Tima Any FA IM ARAM Norberto Fleites, M.D. Settlement Agreement administrative heating, which was assigned DOAH Case No. 05-4665. The Division of Administrative Hearings relinquished jurisdiction to the Agency on January 13, 2006 and then re-opened the case at the Agency’s request on March 21, 2007 and assigned Case No. 07-1288. 4, In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) AHCA agrees to’accept the payment sct forth herein in settlement of the overpayment issues arising from the MPI review. (2) PROVIDER agrees to pay the Agency forty thousand four hundred two dollars and sixty-six cents ($40,402.66), which includes a $3000.00 fine in eight (8) cqual monthly installments including 10% statutory simple interest, with the first payment due on or before May 25, 2007 and on the 25" of each month thereafter. AHCA retains the right to perform a 6 month follow-up review. (3) | PROVIDER and AHCA agree that full payment as set forth above will resolve and settic this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.1. 05-2724- 000. (4) PROVIDER agrees that it will not te-bill the Medicaid Program in any tanner 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 ’ Norberto Fleites, M.D. Settlement Agreement 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. 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 patties 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 Raroivod Timo Anr.94. IM: A5AM Norberto Fleites, M.D. Settlement Agreement 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 thé 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 counterpart. Raroived Timo Any. 9d. IN: 454M Norberto Fleites, M.D. Settlement Agreement Dated: Off 24 2007 py 4 Mechel? Hetty DP (@rnt name) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 ard Keen , Dated: GS , 2007 Linda Keen Inspector General Craig Si Dated: Why ZI __, 2007 General Counsel petty» Dated: _ofseper 2007 . Dexter Assistant General Counsel Dannivod Tima Any 24 IN ARAM age 5 of 8) y aay . PROVIDER ACKNOWLEDGEMENT STATEMENT J MA Gs Geto fle ML ey, on behalf of Norberto Flietes, M.D., (insert printed fall name here) a Medicaid provider operating under provider number 2646064-00, do hereby acknowledge the obligation of Norberto Flietes, M_D. to adhere ta state afd federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, Norberto Flietes, M.D. acknowledges that Medicaid policy requires: }, 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: «Be necessary to protect life, 10 prevent significant illness or significant disability, or to alleviate severe pain; . moo © Be individualized specific, consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s necds, « Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational; * Reflect the level of services that can be safely furnished, and for which no cqually - 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. 2, 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 requiremetits may vary according to the service rendered: history; physical assessment; chief complaint on each visit; diagnostic test and results; diagnosis; treatment plan, including presctiptions; 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. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated November 9, 2005 C.1. #08-2724-000 Roraived Time Anr.?4. 1M: 4AM ‘agg d of B) 5 rated f i 3, The Physicians Coverage and Limitations Handbook requires that if a physician provider employs or contracts with any health care practitioner (physician, physician assistant, or 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 Medicaid 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 enrol] 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 ,. .fecipient, The records must be accessible, legible and comprehensible. Records - must be retained for a period of at Jeast five years from the date of service, and must state the necessity for and the extent of-services provided. These ; __-yequirements 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. we YH? Wedwrto lal . Bye vane RT Return completed acknowledgement statement to Medicaid Program Integrity. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report dated November 9, 2005 Cll. #05-2724-000 Danniuad Tima Ane 8 1M Ab AM

Docket for Case No: 07-001288MPI