STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CITY OF ORLANDO, Petitioner, DOAH CASE NO. 07-347 AHCA NO. 2007008138 Vv. DETERMINATION NO. 20070406-001 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioner filed on July 23, 2007. On July 26, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On August 1, 2007, the Petitioner filed an Amended Notice of Voluntary Dismissal of Petitioner for Administrative Hearing, requesting that DOAH close its file. On August 2, 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 June 26, 2007, Determination is hereby upheld. Unless they have already done so, Petitioner shall submit the correct reimbursement amount as stated in the Agency’s June 26, 2007, Determination to Orlando Regional Healthcare within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Ms. Twan Jackson, Workers’ Compensation Medical Services Unit, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399- 4232. Petitioner shall govern itself accordingly. DONE and ORDERED this Mek day of SS ae , 2008, in Tallahassee, Florida. a fae HOLLY BENSON, Fe 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 L2 day of Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Lawrence P. Stevenson Mari H. McCully, Esquire Administrative Law Judge : Department of Financial Services Division of Administrative Hearings Division of Worker’s Compensation The DeSoto Building 200 East Gaines Street 1230 Apalachee Parkway Tallahassee, Florida 32399-4229 Tallahassee, Florida 32399-3060 Annemarie C. Craft, Esquire Jan Mills Stiles, Taylor, & Grace Facilities Intake Post Office Box 1140 Tallahassee, Florida 32302 Orlando Regional Healthcare Systems Elizabeth Dudek Post Office Box 620000, Stop 9936 Health Quality Assurance Orlando, Florida 32891 Debbie Openshaw James A. Bark 3090 Caruso Court FairPay Solutions, Inc. Orlando, Florida 32806 14295 Midway Road, Suite 300 Addison, Texas 75001

Docket for Case No: 07-003477