STATE OF FLORIDA ~ AGENCY FOR HEALTH CARE ADMINISTRATIO SOUTHEAST PERSONNEL LEASING AND LION INSURANCE COMPANY, INC., Petitioners, DOAH CASE NO. 07-3941 AHCA NO. 2007009421 Vv. DETERMINATION NO. 20070507-004 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / _ FINAL ORDER THIS CAUSE concerns a Petition for Administrative Hearing (“Petition”) that the Petitioners filed on August 21, 2007. On August 28, 2007, the Petition was forwarded to the Division of Administrative Hearings by the Agency and assigned to an Administrative Law Judge (“ALJ”). On October 23, 2007, the Petitioners filed a Notice of Voluntary Dismissal, stating that the parties had resolved the dispute. On October 24, 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 Petitioners’ Petition is dismissed with prejudice and the Agency’s July 27, 2007, Determination is hereby upheld. Unless they have already done so, Petitioners shall submit the correct reimbursement amount as stated in the Agency’s July 27, 2007, Determination to St. Joseph’s Hospital 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 _/6“day of Gece , 2008, in Tallahassee, Florida. a BENSON, eZ Y, 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 ; . fo furnished by U.S. or interoffice mail to the persons named below on this [7 day of J are—, 2008. COPIES FURNISHED TO: Daniel Manry Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230. Apalachee Parkway Tallahassee, Florida 32399-3060 RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 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 Packard Claims Administration, Inc. Post Office Box 1549 Tarpon Springs, Florida 34688 Jan Mills Facilities Intake Elizabeth Dudek Health Quality Assurance FairPay Solutions, Inc. 14295 Midway Road Suite 300 Addison, Texas 75001 St. Joseph’s Hospital Post Office Box 403548 Atlanta, Georgia 30384-3548

Docket for Case No: 07-003941