STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. CASE NO. 08-1815MPI, «2 C.I. NO. 07-5967~900 %, RENDITION NO.: AHCA-08- O@']| -S-MDO LINCOURT PHARMACY CORPORATION, A FLORIDA CORPORATION, Respondent. FINAL ORDER THE PARTIES resolved all disputed issues and executed a “Stipulation and Agreement,” which is incorporated by reference. The parties are directed to comply with the terms of the “Stipulation and Agreement.” Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the et day of SeeT. , 2008, in Tallahassee, Leon County, Florida. Holly Benson, Wecretary Agency for Health Care Administration CASE NO. 08-1815MPI c.I. NO. 07-5967-000 Final Order . 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: Marcos E. Hasbun, Esquire Attorney for Petitioner Zuckerman, Spaeder, LLP 101 East Kennedy Boulevard, Suite 1200 Tampa, Florida 33602 Debora Fridie, Senior Attorney Agency for Health Care Administration (Interoffice) Carolyn S. Holifield Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 D. Kenneth Yon, Interim Inspector General Inspector General’s Office, MS#4 (Interoffice) Finance & Accounting, MS#14 (Interoffice) Medicaid Program Integrity, MS#6 (Interoffice) CASE NO. 08-1815MPI c.r. NO, 07-5967-000 Final Order CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished to the above named addressees by U.S. Mail on this the 7 day of QS SHOVE ber , 2008. Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 08-1815MPI Provider No. 102009900 c.I. No. 07-5967-000 LINCOURT PHARMACY CORPORATION, A FLORIDA CORPORATION, : Respondent. . / STIPULATION AND AGREEMENT The Petitioner, AGENCY FOR HEALTH CARE ADMINISTRATION (a/k/a and hereinafter “AHCA” OR ‘Agency”), and the Respondent, LINCOURT PHARMACY CORPORATION, (a/k/a and hereinafter “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, operating under provider number 102009900. 3. In its Final Audit Report, C.I. No 07-5967-000, (the "Audit Letter" or “FAR”) dated March 21, 2008, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Page 1 of 10 ‘| i i | i i { Case No. 08-1815MPI C.r. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement Agency sought repayment of an overpayment in the amount of $8,426.84. AHCA also notified PROVIDER in the FAR that it is seeking sanctions in the form of a $500.00 fine, a $2,528.05 fine, and a corrective action plan in the form of a provider acknowledgement statement. The sanctions were determined pursuant to Rule 59G-9.070, Florida Administrative Code. In response, PROVIDER petitioned for a formal administrative hearing. After the provider requested a formal administrative hearing, AHCA reviewed documentation that was previously unavailable to them. Based upon that review, AHCA adjusted the overpayment to $2,239.55. PROVIDER has agreed to pay the overpayment amount of $2,239.55. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) .AHCA will accept the payment set forth herein as a complete resolution of the overpayment issues arising from the MPI review cited in paragraph 3 above. (ob) Within thirty (30) days of issuance of the Final Order, PROVIDER agrees to make a single payment to AHCA of Two Thousand Two Hundred Thirty Nine and 55/100 Dollars ($2,239.55). AHCA retains the right to perform a 6-month follow-up review. Page 2 of 10 Case No. 08-1815MPI c.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement (c) (da) (e) (£) PROVIDER is responsible for of the payment. Failure to will render the balance due with interest, and interest until the entire balance is ensuring timely delivery timely make the payment and payable immediately, will continue to accrue paid. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all liabilities arising from the findings in the audit referenced as C.I. Number 07-5967-000. 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. PROVIDER agrees to fully cooperate with any follow up reviews conducted by the Agency. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION ‘ Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a stipulation and agreement and shall reference the C.I. Number and the Provider Number. Page 3 of 10 Case No, 08-1815MPI C.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and 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 Stipulation and Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 8. The parties agree to bear their own attorney’s fees and other costs, if any. 9. As a part of this Stipulation and Agreement, PROVIDER agrees that AHCA may impose an administrative sanction pursuant to Rule 59G-9.070, Florida Administrative Code, as referenced in paragraph 3 above. 10. PROVIDER acknowledges its obligation to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and. policies. Additionally, Lincourt Pharmacy Corporation, d/b/a Lincourt Pharmacy acknowledges that Medicaid policy, as referenced in 409.913, Florida Statutes, the Medicaid Provider Agreement, or the Prescribed Drug Services Coverage, Limitation and Reimbursement Handbook states or requires the following: Page 4 of 10 Case No. 08-1815MPI C.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement . (ay A Medicaid provider agrees to comply with local,-~* state, and federal laws, as well as rules, regulations, and statements of policy applicable to the Medicaid program, including the Medicaid Provider Handbooks issued by AHCA. (b) A Medicaid provider must retain medical, professional, financial and business records pertaining to goods and services furnished to Medicaid recipients for a period of at least five (5) years after the date of furnishing the goods or services. {c) A Medicaid provider must ensure that submitted claims are true and accurate and that the goods and services have actually been furnished to the recipient by the provider prior to submitting the claim. (d) A Medicaid provider must, as set forth in the Final Audit Report for C.I. No. 07-5967-000, 1. Ensure that the number of refills billed to Medicaid is the same as that which is authorized by the prescriber, 2. Ensure that the prescriber identified on the claim billed to Medicaid is the same as that which is on the original prescription, and Page 5 of 10 Case No. 08-1815MPI C.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement zs. Maintain purchase acquisition records for products dispensed and demonstrate the availability of sufficient quantities of goods to support billings. 11. The signatories to this Agreement, acting ina representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Stipulation and Agreement to AHCA; however a facsimile copy shall be sufficient to enable AHCA to cancel a hearing scheduled in this case. 12. 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. 13. This Agreement constitutes the entire agreement between PROVIDER and ANCA, 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 AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a Page 6 of 10 Case No. 08-1815MPI C.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement written amendment to the Agreement is completed and properly .~ executed by the parties. 14. 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. This Stipulation and Agreement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be resolved because the parties have agreed to the terms contained within this agreement. 15. 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 rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that the Agency should issue a Final Order which Page 7 of 10 Case No. 08-1815MPI C.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement is consistent with the terms of this Stipulation-and Agreement, - and which adopts this agreement and closes this matter. 16. PROVIDER does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses,. of any and every nature whatsoever, arising out of or in any way related to this matter, C.I. No. 07-5967-000, and AHCA’s actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Provider. 17. This Stipulation and 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. 18. To the extent that any provision of this Stipulation and 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 Stipulation and Agreement. Page 8 of 10 Casa No, O8-L915MeI Get. Now 07~-5967*000 Dincourt Abormacy Corporation 7a.. 3BCA gedpuiation and Agresmant This stipulation and agreement shall inure. B SUCcceRSOLS, assigns, 13. to the benefit of and be binding on each party‘ yepresentatives and trustees, neira, administrators, 20, ALL times stated herein are of tha assence in this Stipulation and Agraament . 21. hia Stipulation and Agreement shall be da full force and effect upon execution by the vegpective parties in counterpart. PETIZIONER LINCOURT PHARMACY CORPORATION veo MARCOS B, HASBUN,—SSQUIRG Attosnay for Petitioner LINCOURT PHARMACY CORPORATION — wee Date: TT f . » 2008 Pagn § of 10 Case No. 08-1815MPI C.I. No. 07-5967-000 Lincourt Pharmacy Corporation vs. AHCA Stipulation and Agreement AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 BY: Ll 4, Fu LINDA KEEN Inspector General Date: s/o 8 , 2008 BY: General Counsel Date: F [27 , 2008° FRIDIE Assistant General Counsel Date: (£7 G , 2008 Page 10 of 10 Corrective Action Plan — Acknowledgement Statement A “corrective action plan” is the process or plan by which the provider will ensure future compliance with state and federal Medicaid laws, rules, provisions, handbooks, and policies. For purposes of this matter, the sanction of a corrective action plan shall take the form of an “acknowledgement statement”, which is a written document submitted to the Agency within 30 days of the date of the Agency action that brought rise to this requirement. An acknowledgement statement: identifies the areas of non-compliance as determined by the Agency in this Final Audit Report (FAR); acknowledges a requirement to adhere to the specific state and federal Medicaid laws, rules, provisions, handbooks, and policies that are at issue in the FAR; and, must be signed by the provider or its president, director, or owner. The acknowledgement statement is due to Medicaid Program Integrity within 30 days of the issuance of this FAR. Please sign the enclosed statement and return it to: Kathryn N. Holland, C.Ph. Agency for Health Care Administration Medicaid Program Integrity 2727 Mahan Drive, Mail Stop # 6 ‘Yalahassee, FL 32308-5403 Phone (850) 921-1802 Facsimile (850) 410-1972 Failure to comply with the requirements set forth above may result in the imposition of additional sanctions, which may include monetary fines, suspension, or termination from the - Medicaid program. Corrective Action Plan -- Acknowledgement Statement Final Agency Andit Report dated March 2! , 2008 CL 07-5967-D00/P/KNH PROVIDER, ACIQNOWLEDGEMENT STATEMENT I “Lowes FE Lap son) on behalf of Lincomt Pharmacy Corporation, d/b/a Lincourt Pharmagy, # a Medicaid provides operating under provider number 102009900, de hereby asknowledge the obligation of Lincourt Pharmacy Corporation, d/b/a Lincourt Pharmacy to adhere 10 state and federal Medicaid Jaws, roles, provisions, handbooks, and policies, Additionally, Linoourt Pharmacy Corporation, d/b/a Lincourt Pharmecy acknowledges that Medicaid policy, as referenced in 409.913, Florida Statutes, the Medicaid Provider Agreement, or the Prescribed Drug Sarvicse Coverege, Livitation and Reimbursement Handbook states or requires the following: 1. A Medicaid provider agrece to comply with local, state, and federal Jaws, as well a rules, regulations, and statements of policy applicable fo the Medicaid program, including the Medicaid Provides Handbooks issued by AHCA, : 2. A Medicaid previder mist retain medical, professional, financial and business recards pertaining to goods and services furniched to Medicaid rocipients for a period of at least five (5) years after the date of finishing the goods or services. 3. A Medicaid provider must ensure thet submitted’ claims are true and accurate and that the goods and services have'actually been furnished to the recipient by the poder F prior to submitting the claim. . ‘ 4, A Medicairl provider must, as yeferred to in the Final Audit Report far CI. No. 07-5967-000, a. Ensure that the number of reills billed to Medioaid is the samo as that which 3s authorized by the prescriber, b. Ensure that the prescriber identified on the claim billed to Medicaid is the game as that whioh is on the original prascription, and 0. Maintain purchase acquisition records for products dispensed and demonsmate cient quantities of goods to support billings. Date: war ntey-a towed! Integr complated ackuuwledgt Cartoctivt Action Plan ~ Acknowledgement Sumatieat Fino] Agenoy Ansit Report dated Dfatoh 21, 2008 CLL 07-5061-000//KNA ee ne

Docket for Case No: 08-001815MPI