STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION HM APR 1S 2 Of LION INSURANCE COMPANY, Petitioner, DOAH CASE NO. 07-1665 AHCA NO.2006010444 DETERMINATION NO. 20060818-003 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, SONMV SH IAL oO = “oO ~ a "oO = Respondent, rr) = mod FINAL ORDER THIS CAUSE concerns an Amended Petition for Administrative Hearing (“Petition”) that the Petitioner filed on February 8, 2007. On April 11, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On July 31, 2007, the Petitioner filed a Notice of Voluntary Dismissal of Petition for Administrative Hearing, stating it was voluntarily dismissing its Petition with prejudice. On August 1, 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 October 19, 2006, Amended Determination is hereby upheld. Unless it has already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s October 19, 2006 Amended Determination to St. Petersburg General Hospital within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Welby Cox-Meyers, R.N., AHCA WC Med Services, Division of Worker’s Compensation, 200 East Gaines Street, Tallahassee, Florida 32399-4229. Petitioner shall govern itself accordingly. DONE and ORDERED this PE day of _ ¢ I , 2008, in Tallahassee, Florida. HOLLY BENSON, Secretary 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 furnished by U.S. or interoffice mail to the persons named below on this _/S day of Aci! _., 2008. COPIES FURNISHED TO: Honorable T. Kent Wetherell, II Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Mari H. McCully, Esquire Department of Financial Services Division of Worker’s Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Timothy L. Newhall, Esquire Stiles, Taylor & Grace, P.A. Post Office Box 1140 Tallahassee, Florida 32302-1140 Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3. Tallahassee, Florida 32308 (850) 922-5873

Docket for Case No: 07-001665