FILED STATE OF FLORIDA _, AHCA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY CLERK 1081 OCT ~4 > x gp AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH CASE NO. 07-1977MP1 C.L. No. 07-5280-000 \ JUDGE: LINDA M. RIGOT RENDITION NO.: AHCA-07- QLeOG5- Dee MARE, INC., d/b/a MARE PHARMACY . DISCOUNT, VS. Respondent. / RE FINAL ORDER Bo: v S- LOE 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 _/ day of (et , 2007, in Tallahassee, Florida. poe 1k Cc. dad, Secretary Vim 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) Lawrence R. Metsch, Esq. The Metsch Law Firm, P.A. 20801 Biscayne Blvd., Suite 307 Aventura, FL 33180-1423 (U.S. Mail) - The Honorable Linda M. Rigot Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) 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 tiny of _Cetpber, 2007. ae Richard Shoop, Agency Clerk 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 DIVISION OF ADMINISTRATIVE HEARINGS ‘ 0 AGENCY FOR HEALTH Cage WL 14 200? ADMINISTRATION, Petitioner, vs, we CASE NO. 07-1677MP1 MARE, INC. d/b/a MARE PHARMACY DISCOUNT Respondent. ee | SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Mare, Inc. d/b/a Mare Discount Pharmacy (“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 022474000 and was a provider during the audit period, 3. In its Final Audit Report (final agency action) dated March 2, 2007, 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 pan, has been inappropriately paid by Medicaid. The Agency sought recoupment. of. this overpayment, in the amount of $195,515.89, a fine sanction of $5,000.00 for violation(s) of Rule 59G-9.070(7)(n) F.A.C.. In Tesponse to the audit letter dated March 2, 2007, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No, 07- 1677MPI. AAS?T AARE-GE-TWIL * Mare, Inc. d/b/a Mare Discount Pharmacy Settlement Agreement 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 set forth herein in settlement of the overpayment issues arising from the MPI review, (2) PROVIDER agrees to pay the Agency two hundred thousand five hundred eighteen dollars and eighty nine cents ($200,515.89), which includes $5,000.00 in sanctions, in twelve (12) equal monthly payments including “10% statutory simple interest, with the first payment due on or before September 1, 2007 and on the 1" of each month thereafter in full and complete settlement of all claims. 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 settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.1, 07-5280- 000. (4) PROVIDER agrees that it will not re-bill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case, 3. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 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 Aree antoarser ". Mara, Inc, d/b/a Mare Discount Pharmacy Settlement Agreement notice, to withhold the total remaining amount due under the tenns 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 attomeys’ 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 Tespective parties, ll. 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, conceming 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 parties may have different or incorrect understandings, information and contentions, as to facts and law, and with each party compromising and settling “any ‘potenitial correctness or incorrectness of its understandings, information and contentions as to facts and Jaw, so that no misunderstanding or misinformation shall be a ground for rescission hereof, Brest JARS ATI my Mare, Inc. d/b/a Mare Discount! Pharmacy Ww Settlement Agreement 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 jt may be entitled by Jaw or Tules 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 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 Teason, 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. At:FT JARe-Ae Te Besrzang Mara, Inc. d/n/a Mare Discount Pharmacy Satlement Agraament MARE, + Viva MaRp DISCouNT PHARMACY AGENCY FoR REALTE CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL, 32308-5403 Deed: oo FX , 2007 Dexter. Assistant General Counse] TET LGRE-BE-WE . ead ween a PHL (Page 1 af 7) FIDGA AGERICY FOR HEALTH CART ATAUNSTRATION CHARLIE CRIST . ANDREW C. AGWUNOBI, M.D. GOVERNOR BEGRETARY CERTIFIED MAIL No. 7004 2510 0001 4447 0593 March 2, 2007 Provider No.: 0224740 00 License No,; PH0009053 Ana Nelida Cabrera, President Mare, Ine, d/b/a Mare Pharmacy Discount 5350 Palm Avenue tHinleah, FL 33012 In Reply Refer to o FINAL AUDIT REPORT C,], No, 07-5280-000/P/KNE Dear Mz, Cabrera; The Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Integrity, has completed a review of claims for Medicaid reimbursement for dates of service during the period January 1, 2005, through December 31, 2005. A preliminary audit report dated Junuary 31, 2007 was sent to you indicating that we had determined you were overpaid $195,515.89, Based upon a review of all documentation submitted, we have determined (hat you were overpaid $195,515.89 for services that in whole or in part are not covered by Medicaid, A fine of 55,000 has been applied, The total amount due is $200,515.89, ' Be advised of the following: (1) Pursuant to Section 409.913(23)(a), Florida Statutes (F.S,), the Agency is entitled to recover all investigative, legal, and expert witness costs, (2) In accordance with Sections 409.913(15), (16), and (17), F.S., and Rule 59G-9,070, Florida Administrative Code (F.A.C,), the Agency shall apply sanctions for violations of federal and state laws, including Medicaid policy, This letter shall serve as notice of the following sanction(s): eA fine of $5,000 for violation(s) of Rule Section 590-9.070(7)(n), F.A.C. FLORIDA Visil AHCA online of 1G facusttetunie hiip:/iahea, myflorida,com Rie Www.FlarldaGompareCare.gov “Reina SmpareCare,g! 2727 Mohan Orlve, M5e B Tallahasseo, Flosida 32908 (Page 2 of 7) Mare, Inc, d/b/a Mare Pharmacy Discount Case 07-5280-000/P/KNH Page 2 . . This review and the determination of overpayment were made in accordance with the provisions of Section 409.913, F.S. In determining the appropriateness of Medicaid payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies, limitations and requirements found in the Medicaid provider handbooks and Section 409,913, F.5, In applying for Medicaid reimbursement, providers are required 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, Medicaid cannot pay for services that do not meet these guidelines, : Below is a. discussion of the particular guidelines related to the review of your claims, and an explanation of why these clalms do not meet Medicald requirements, The audit work papers arc attached, listing (he claims that are affected by this determination, REVIEW DETERMINATION(S) The audit included two reviews, 4 prescription medical records review and a purchasc acquisition records review, The outcome of both reviews determined the final overpayment due as well as the sanctions imposed, ‘The audit included the review of a judgmental sample of svlected claims taken from the population of paid claims with dates of service during the audit period, The audit period for this review was from January 1, 2005, through December 31, 2005. This review identified an overpayment of $396.49. Enclosed for this review are the overpayment calculations, a summary of documented discrepancies, and an itemized listing of discrepancies noted In the review of the judgmental sample. : ‘The audit included a comparison of your lawful documented product sequisitions with your paid Medivnid claims, Only product acquisitions fram Florida licensed wholesalers were included in the audit, The-audit period for this review was from January 1, 2005, through December 31, 2005, The drug quantity paid for by Medicaid for the drugs reviewed exceeded the quantity available Lo dispense to Medicaid recipients. This review Identified an overpayment of $195,515.89, Enclosed for this review are the overpayment calculations which include the summary sheel(s), pald claims duta, and acquisition data, If you are currently invalved {na bankruptcy, you should notify your attorney immediately and provide a copy of this letter for them, Please advise your atlomey thal we need the following informution immediniely: (1) the date of ling of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed (e.g, Northern District of Florida, Tallahassee Division); and, (4) the name, address, and telephone number of your atlomey, . {Page 3 of 7) Mare, Inc, d/b/a More Pharmacy Discount Case 07-5280-000/P/KNH Page 3 . om If you are not in bankruptey and you concur with our findings, remit by certified check in the umount of $200,515.89, which includes the overpayment smount as well as any fines imposed, The check must be payable to the Florida Agency for Health Care Administration, Questions regarding proceduras for submitting payment should be directed to Medicaid Accounts Reecivable, (850) 488-5869. To ensure proper vredil, be certain you legibly record on your check your Medleald provider.number and the C.J, number listed on the first page of this audit ‘report, Please mail payment to: Agency for Health Care Administration Medicaid Accounts Receivable P.O, Box 13749 Tallahassee, Florida 32317-3749 If payment is not received, or arranged for, within 30 days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Chapter 409.913(27), F.S, Furthermore, pursuant to Sections 409,913(25) and 409,913(15), F.S., failure to pay in full, or enter into and abide by the terms of any repayment schedule set forth by the Agency may result in termination from the Medicaid Program, Likewise, failure lo comply with ull sunctions applied or due dates may result in-additional sanctions being imposed, You have the right to request a formal or informal hearing pursuant to Section 120.569, FS. Ifa request for a formal hearing is made, the petition must be made in compliance with Section 28- 106,201, F.A.C. and mediation may be avullable. Ifa request for an Informal hearing is made, the petition must be made in compliance with rule Section 28-106,301, F.A,C. Additionally, you arc hereby informed that if a request for a hearing is made, the petition must be reccived by the Agency within twenty-one (21) days of receipt of this letter, For morc information regarding your henring and mediation rights, please sce the attached Notice of Administrative Hearing and Mediution Rights. : Any questions you may have ubout this matter should be directed lo; Kathryn N, Holland, Senior Pharmacist, Agency for Heulih Care Administration, Medicaid Program Integrity, 2727 Muhun Drive, Mail Stop #6, Tallahassee, Floride 32308-5403, telephone (850) 921- 1802, facsimile (850).410-1972. : Sincerely, BD hog D, Kenneth Yon AHCA Administrator Enclosure(s) eo; Benjamin R, Metsch The Metsch Law Firm, PA, (Pane 4 of 7) More, Inc, Co d/b/a Mare Pharniacy Discaunt Case 07-5280-000/P/KNH Page 4 ee ee ee NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS You have the right to request an administrative hearing pursuant to Sections 120,569 and 120.57, Florida Statutes, If you disagree with the facts stated in the foregoing Final Audit Report (hereinafter FAR), you may request a formal administrative hearing pursuant to Section 120.57(1) Florida Statutes, [f you do nat dispute the facts stated in the FAR, but believe there are additional reusons to grant the relief you seek, you may request an informal administrative hearing pursuant 1o Section 120.57(2), Florida Statutes, Additionally, pursuant to Section 120,573, Florida Statutes, mediation may be available if you have chosen a formal administrative hearing, as discussed more fully below, ; . : ‘The written request for an administrative hearing must conform to the requirements of either Rule 28-106,201(2) or Rule 28-106,301(2), Florida Administrative Code, and must be received by the Assistant Bureau Chief by 5:00 P.M, no later than 21 days after you received the FAR, The address for filing the written request lor an administrative hearing is: Assistant Bureau Chief 7 Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 The request must be legible, on 8 ¥% by 11-Inch white paper, and contain; 1. Your name, address, telephone number, any Agency identifying number on the FAR, if known, and name, address, and talephone number of your representative, if any; . 2, An \expianation of how your substantial interests will’be affected by the action described in the FAR; 3. A sintement of when and how you received the FAR; 4. Fora request for formal hearing, a statement of all disputed issues of material fuct, 5, For arequest for formal hearing, a concise statement of the ultimate facts alleged, as well as the rules and statutes which entitle you to relief; 6. For a request for formal hearing, whe 7, Fora request for informal hearin to the Avency; and 8. A demand for relicf, er you request mediation, if it is available; g, What bases support an adjustment to the amount owed A formal hearing will be held if there are disputed issues of material fact, Additionally, mediation may be available in conjunction with a formal hearing, Mediation is a way to use a neutral third party to assist the parties In a legal or. administrative proceeding to reach a settlement of their case. If you and the Agency agree to mediation, it does not mean that you aive. up the right to.a hearing, Rather, you and the Agency will try to scttle your case first with mediation. If you request mediation, and the Agency agrees to if, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation ngreement, If a mediation agreement is not reached within 10 days following the request for mediation, the matter will proceed without mediation, The mediation must be concluded within 60 days of having entered into the ngreement, unless you and the Agency agrec to a different time period, The mediation agreement between you and the Agency will include provisions for sclecting the mediator, the allocation of costs and fees assoclated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees that must be shored equally by you and the Agency. sO Ifa written request For an administrative hearing is not timely received you will have waived your right to hove the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set forth in the FAR shal] be conclusive and final (Page & of 7} se°sts'set$ yuawAedaag jejOL ZE“ETS‘SE oOL80°9T Tzsc TEE ose 6tts"0 =L0TE se-sctoe 86 ZSBE qiget Bug, exaudéz zo"fee’s TeES°6 BLE oo9 ° 003 oooo"T =aeST ZpSEtST LST yaigeL Bw} exasdéz EL ETT'L te.g'2 «= e99e soz o8Ts Tesa°O 8 TETZT gz-sy0sz TLe0T jagiek Sung, yoioz Sa’sez's ETRY b 596 BLOF OTL 6y9g-0 09 -SzBS BL-SLEZZ SEOs 21921 Guppy sosoz LUOSBT’E Q9Eb°b. 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Discrepancies Documented No, Discrepancies Cote wo Discrepancy Description The claim for the prescription contains an Incorrect prescriber license number. The number of refills billed and pald tc the pharmacy exceeds the number authorized by prescriber, Refllis are dispensed without documented authorization from the prescriber, Inapproprialely transferred prescription, Tolal Overpayment $396.49 {Page 7 cf 7) Bbsees soBreyareng IROL OC PER — WnoWy Ped IBIOL ie'see OSIM. ° «ISSEt «=6O—spsabzns0000 Fiupzsssoz «on «= D'S SOGZ/L} «SEZPSOOSW «= Opevoay‘osuony = cpASSOD §=— ORE “ep = BEEZSONSL Be LoL un aflvL = = ORaPZOsSHeS Bugpidesuy of OOTE SORL/ZG ISEZb00SIN oveqolly ‘zanBupoy OnLesen woWweY “ame, Epes EPSESRs 25641 un és vb M ABYESEESDOO."Buppyecy onsale $2 ODUPZ SOTO. 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Docket for Case No: 07-001677MPI