FILED AHCA STATE OF FLORIDA AGENCY CLERK DIVISION OF ADMINISTRATIVE HEARINGS 2001 JUN 28 A 802 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH CASE NO: 07-1994MPI v. provider no.: 025325100 audit no.: 07-5238-000 AKSHAR CHEMISTS, INC. d/b/a RENDITION NO.: AHCA-077-03 4 Z -S-MDO THE MEDICINE SHOPPE, Respondent. / FINAL ORDER py oF THE PARTIES resolved all disputed issues and executed a Settlgment 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 AY day of Ane , 2007, in Tallahassee, Florida. jor. ARE 2 Asan M.D., SECRETARY HO ANDRE 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) James M. Barclay, Esquire Ruden, McClosky, Smith, Schuster & Russell, P.A. 215 S. Monroe Street, Suite 815 Tallahassee, Florida 32301 (U.S. Mail) Carolyn Holifield Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Diana Coumbe, Medicaid Program Integrity Finance and Accounting 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 Ze aay of kre, 2007. Richard Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH CASE NO: 07-1994MPI v. provider no.: 025325100 ~ audit no.: 07-5238-000 AKSHAR CHEMISTS, INC. d/b/a THE MEDICINE SHOPPE, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Akshar Chemists, Inc. d/b/a The Medicine Shoppe (“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 025325100 and was a provider during the audit period. 3. In its Final Agency Audit Report (final agency action) dated April 11, 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 part, had been inappropriately paid by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $66,640.81. In response to the audit letter dated April 11, 2007, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 07-1994MPI. TAL:58697:1 Akshar Chemists, Inc. d/b/a The Medicine Shoppe Settlement Agreement 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: TAL:58697:1 qv) @) (3) (4) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of entry of the final order, PROVIDER agrees to make a lump sum payment of sixty six thousand six hundred forty dollars and eighty one cents ($66,640.81) in full and complete’ settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 07-1994MPI). AHCA retains the right to perform a 6-month follow-up review. 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. 07-5238- 000. PROVIDER 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 HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Akshar Chemists, Inc. d/b/a The Medicine Shoppe 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. TAL:58697:1 Akshar Chemists, Inc. d/b/a The Medicine Shoppe Settlement Agreement 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 potential correctness or 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 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 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. TAL:58697:1 Akshar Chemists, Inc. d/b/a The Medicine Shoppe Settlement Agreement 19. This Agreement shall be in full force and effect upon execution by the respective AKSHAR CHEMISFS, INC. d/b/a THE MEDICINE SHOPPE pated: 5 {16 2007 | AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 TAL58697:1 (Page 1 of 4) FLORIDA AGENCY [OR HEALTH CARE ADMINISTRATION: CHARLIE CRIST ANDREW aGWuNodt wy GOVERNOR SEA v OF! CERTIFIED MAIL — RETURN RECEIPT No. 7004 2510 0001 4446 9542 Mls OF April 11, 2007 Provider No.: 025325100 License No.: PH1!8507 Pharmacy Manager Akshar Chemists, Inc. d/b/a The Medicine Shoppe a 01-199 MPE In Reply Refer to FINAL AUDIT REPORT C.I. No. 07-5238-000/P/DSC Dear Provider: 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 February 1, 2004 through January 31, 2005. An Amended Preliminary Audit Report dated November 30, 2006 was sent to you indicating that we had determined you were overpaid $67,122.24, Based upon a review of all documentation submitted, we have determined that you were overpaid $66,640.81 for services that in whole or in part are not covered by Medicaid. Additionally, be advised of the following: Pursuant to Section 409.913(23)(a), Florida Statutes (F.S.), the Agency is entitled to recover all investigative, legal, and expert witness costs. 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, ¥.S. In applying for Medicaid reimburscment, 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 bullctins, 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 claims do not meet Medicaid requirements. The audit work papers are enclosed, listing the claims that are affected by this determination. a ? FLORIDA Visit AHCA online at DOMPARE CARE hitp://ahca.myflorida.com Health Care in the Sunshine: 2727 Mahan Drive. MS# 6 Tallahassee, Florida 32308 # ap New FlorigaCompareCare.gov (Page 2 of 4) Akshar Chemists, Inc. ep / Provider 025325100 ‘ Page 2 of 4 ” “0 “8 b REVIEW DETERMINATION(S) Y 3. Gy Ap, The following review determinations were made by applying Medicaid policy to a “E ig claims on the attached claims detail printout. The July 2001, Florida Medicaid Prescri Services Coverage, Limitations and Reimbursement Handbook, page 9-15 states: Kit Dosage Forms: “Some injectable products are prepackaged in unit-of-use kits, such as saline flush kits (2-saline-filled syringes and 1 heparin-filled syringe all in one plastic bag). Each “kit” is billed as a quantity of “1”. Also page 9-18 of the Florida Medicaid Prescribed Drug Services Coverage, Limitations and Reimbursement Handbook lists the following dosage forms that are expressed as “Each”: ® “Most products packaged in kits * Powder-filled vials, amps and syringes for injection, irrigation, or inhalation (the quantity is the total number of vials dispensed, not the mls or gms of final product).” ‘The injectable medication Risperdal Consta is packaged as one (3) syringe which contains diluent for reconstitution and one (1) vial of medication powder. This product like the examples above should be billed as one (1) kit or by “each” dosepak. The recommended dose of Risperdal Consta is 25mg, 37.5 mg or 50mg every two (2) weeks by deep intramuscular gluteal injection. This dose should be billed as one (1) dosepak every two (2) weeks or typically two (2) dosepaks per month. We have determined that you inappropriately over billed Florida Medicaid for certain paid claims submitted for prescription orders with dates of service falling within the review period. It appears you billed by the reconstituted amount of 2 ml per syringe and not by the syringe or each dosepak. This action resulted in an over payment for certain prescription orders. The overpayment total for all claims for this review is $66,640.81. A report containing the applicable claims with the calculated overpayments is enclosed for your review. If you are currently involved in a bankruptcy, you should notify your attorney immediately and provide a copy of this letter for them. Please advise your attorney that we need the following information immediately: (1) the date of filing 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, Tallahassce Division); 8 and, (4) the name, address, and telephone number of your atlorney. If you are not in bankruptcy and you concur with our findings, remit by certified check in the amount of $66,640.81, which includes the overpayment amount as well as any fines imposed. The check must be payable to the Florida Agency for Health Care Administration. Questions (Page.3 of 4) , Akshar Chemists, Inc. Provider 025325100 Page 3 of 4 regarding procedures for submitting payment should be directed to Medicaid Accounts Receivable, (850) 488-5869. To ensure proper credit, be certain you legibly record on your check your Medicaid provider number and the C.I. 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 thirty (30) days of receipt of this letter, the Agency may withhold Medicaid payments in accordance with the provisions of Section 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 to comply with all sanctions 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, F.S. 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 available. If a 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 are hereby informed that if a request for a hearing is made, the petition must be received by the Agency within twenty-one (21) days of reccipt of this letter. For more information regarding your hearing and mediation rights, please sec the attached Notice of Administrative Hearing and Mediation Rights. Any questions you may have about this mattcr should be directed to: Diana Coumbe, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahan Drive, Mail Stop #6, Tallahassee, Florida 32308-5403, telephone (850) 921-1802, facsimile (850) 410-1972. Sincerely, Db — D. Kenneth Yon AHCA Administrator DKY/ dsc Enclosure(s) ce: James Barclay Medicaid Accounts Receivable dsc RX FAR AKSHAR.doc {Page4 of 4) . Akshar Chemists, Inc. " Provider 025325100 pe Page 4 of 4 o “ MED NOTICE OF ADMINISTRATIVE HEARING AND MEDIATION RIGHTS | on by is, You have the right to request an administrative hearing pursuant to Sections aos a 120.57, Florida Statutes. If you disagree with the facts stated in the foregoing Final Audit R & (hereinafter FAR), you may request a formal administrative hearing pursuant to Section 120.57(1 Indi, Florida Statutes. If you do not dispute the facts stated in the FAR, but believe there are additional SE Teasons to grant the relief you seek, you may request an informal administrative hearing pursuant to Section }20.57(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 y below. The written request for an administrative hearing must conform to the requirements of cither 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 for an administrative hearing is: Assistant Bureau Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tailahassce, Florida 32308 - 5403 ‘The request must be legible, on 8 4 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 telephone number of your representative, if any; ; An explanation of how your substantial interests will be affected by the action described in the FAR; A statement of when and how you received the FAR; . For a request for formal hearing, a statement of all disputed issues of material fact; For a request for formal hearing, a concise statement of the ultimate facts alleged, as well us the rules and statutes which entitle you to relief; For a request for formal hearing, whether you request mediation, if it is available; For a request for informal hearing, what bases support an adjustment to the amount owed to the Agency; and A demand for relief. eo ND wae oN 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 give 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 it, you will be contacted by the Agency to set up a time for the mediation and to enter into a mediation agreement. 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 agreement, unless you and the Agency agree to a different time period, The mediation agreement between you and the Agency will include provisions for selecting the mediator, the allocation of costs and fees associated with the mediation, and the confidentiality of discussions and documents involved in the mediation. Mediators charge hourly fees that must be shared equally by you and the Agency. Ifa written request for an administrative hearing is not timely received you will have waived your right to have the intended action reviewed pursuant to Chapter 120, Florida Statutes, and the action set forth in the FAR shall be conclusive and final. .

Docket for Case No: 07-001994MPI