STATE OF FLORIDA 30 AGENCY FOR HEALTH CARE ADMINISTRATION os eg 5 . C. BARNABAS NEUSCH, M.D. Eee? A Sug Petitioner, CASE NO. 08-4893MPI . FORMERLY CASE NO: LT 08-212P MPI CASE NO. 08-6722-000 vs. RENDITION NO.: AHCA-08- (1 #2: -S-MDO STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement, which is attached and incorporated by reference. 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 “Pecewnloor_, 2008, in Lh. Holly Benson, Secretary Agency for Health Care Administration Tallahassee, Leon County, Florida. APARTY 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: Stuart M. Lerner, Administrative Law Judge DOAH (Fax # 850-921-6847) C. Barnabas Neusch, M.D. 2273 SE 9" Street Pompano Beach, Florida 33062 Willis F. Melvin, Jr., Senior Attorney Agency for Health Care Administration (Interoffice) Terri Dean and/or Robi Olmstead AHCA Administrator (Medicaid Program Integrity) Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #21 (Interoffice) Finance & Accounting (interoffice) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was served to the above named addresses by U.S. Mail this 52 day of _ Z@re-€2/_, 2008. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, VS. Case No. 08-4893MPI Formerly Case No: LT 08-212PH C. BARNABAS NEUSCH, M.D. Respondent. / SETTLEMENT AGREEMEN T STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and C. BARNABAS NEUSCH, M.D. (“PROVIDER”), by and through the undersigned, hereby stipulates and agrees as follows: I. This Agreement is entered into for the purpose of memorializing the final resolution of the matters set forth in this Agreement. 2. PROVIDER is a Medicaid provider (Medicaid Provider No. 052413100) in the State of Florida. 3. In its final audit report (F AR) dated March 21, 2008 for the case referenced as C.I. No. 08-6722-000, 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 Agency sought overpayment in the amount of $2,093.30. In response to the FAR, PROVIDER filed a petition for an informal administrative hearing. AHCA also imposed a fine of $500.00, and a cost of $500.00, for a total balance of $3,093.30. After the informal hearing concluded that there were disputed issues of fact, the case was transferred to the Division of Administrative Hearings. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (G1) — AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI reviews. (2) PROVIDER agrees to make a single payment of three thousand, ninety three dollars and thirty cents ($3,093.30), in full and complete settlement of all claims in this matter, within 30 days of issuance of a Final Order adopting this agreement. This amount will be credited as $2093.30 to remedy the adjusted overpayments and $500.00 to remedy the fines and $500.00 to remedy the costs. . (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 audits referenced as C.I, No. 08-6722-000. (4) 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 audits in this case. | 5. - The PROVIDER shall file a corrective action plan in the form of an acknowledgement statement within thirty (30) days of the entry of the Final Order as was required in the Final Audit Report issued on March 21, 2008. 6. PROVIDER acknowledges their obligation to adhere to state and federal Medicaid laws, rules, provisions, handbooks and policies. 7. PROVIDER agrees 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, and agrees that Medicaid does not pay for services that do not meet these guidelines. 8. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 9. 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. 10. 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. LL. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 12. Each party shall bear its own attorneys’ fees and costs, if any, except as set forth herein. . 13. 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. . 14. 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. 15. 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. 16. 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. 17. | 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 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. 18. 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. 19. 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. 20. This Agreement shall imure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 21. All times stated herein are of the essence of this Agreement. 22. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. 23. In the event either party breaches this Agreement, the costs and attorney fees incurred by the non-breaching party associated with enforcement or collection activity pertaining: to this Agreement shall be paid by the party breaching this Agreement to the non-breaching party. C. BARNABAS NEUSCH, MD. C. Barnabas Neusch, 1d. Dated: Dec. OA _, 2008 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (hs C Peter Williams Inspector General LO 5 / LM jber Datea. 12/78 2008 nk Senion ; Acting General Counsel < Raxttaok ‘lf be Dated:_/ a I} , 2008 Kim Kellum’ ; , 2008 Dated: JR 9 , 2008 Dated: Assistant General CoupSel 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: Gloria Derby, Sanction Coordinator Agency for Health Care Administration Medicaid Program Integrity 2727 Mahan Drive, Mail Stop # 6 Tallahassee, 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 Audit Report March 21, 2008 C.I, 08-6722-000 PROVIDER ACKNOWLEDGEMENT STATEMENT 1 C. Barnabas Newsch mp _ on behalf of BARNABAS C NEUSCH MC, (insert printed full name here) a Medicaid provider operating under provider number 0524 13100, do hereby acknowledge the obligation of BARNABAS C. NEUSCH MC, to adhere to state and federal Medicaid laws, rules, provisions, handbooks, and policies. Additionally, BARNABAS C. NEUSCH MC, acknowledges that Medicaid policy requires: 1. The Medicaid Physician Services Coverage and Limitations Handbook, Chapter 2, Obstetrical Care Services, states the following: Prenatal Visit Frequency “Prenatal visits are limited to a maximum of 10 per recipient. Additional visits, up to a total of 14, may be reimbursed if the diagnosis is listed in Appendix A, Diagnosis Code List for Additional Prenatal Services for Pregnant Women. Payment for prenatal care is based on a total amount for complete: care. Reimbursement for the 10 or 14 visits is the maximum reimbursement for the full course of prenatal care. If additional visits are provided, payment is considered already made in full. The provider may not bill the additional visits to Medicaid or the recipient.” 2. The Medicaid Physician Services Coverage and Limitations Handbook, Chapter 2, Obstetrical Care Services, states the following: Florida’s Healthy Start Prenata! Risk Screening “The Healthy Start Prenatal Risk Screening should be offered at the first prenatal visit. The prenatal visit that includes completion of the Healthy Start Prenatal Risk Screening is reimbursed once per pregnancy by billing procedure code H1001, if the Healthy Start Prenatal Risk Screening is completed during the first trimester, procedure code H1001 with modifier TG shouid be billed. H1001 is included in the total number of prenatal visits.” 3. Per the same policy as stated in Issue 2, if this screening is completed during the first trimester, you are allowed a higher payment; the screening completed after the first trimester pays a lower amount. If the higher amount was billed after the Corrective action plan -- Acknowledgement Statement Final Agency Audit Report March 21, 2008 C.J. 08-6722-000 first trimester, the difference in the reimbursement amount between procedure codes H1001 and H1001 with modifier TG would be considered an overpayment. The Florida Medicaid Provider General Handbook, Record Keeping Requirements, states on page 2-44: “Medicaid requires that the provider retain all medical, fiscal, professional and business records on all services provided to a Medicaid recipient. Records can be kept on paper, magnetic material, film or other media including electronic storage, except as otherwise required by law or Medicaid requirements. In order to qualify as a basis for reimbursement, the records must be signed and dated at the time of service, or otherwise attested to as appropriate to the media. Rubber signatures must be initialed. The records must be accessible, legible and comprehensible.” The Florida Medicaid Provider General Handbook, Chapter 2, Record Keeping Requirements states: Page 2-45, Right to Review Records . "The provider must send, at his or her expense, legible copies of all Medicaid- related information to the authorized state and federal agencies and their authorized representatives upon request of AHCA. At the time of the request, all records must be provided regardiess of the media format on which the original records are retained by the provider. All medical records must be reproduced onto paper copies.” . This handbook further states on page 2-46, Incomplete Records “Providers who are not in compliance with the Medicaid documentation and record retention policies described in this chapter may be subject to administrative sanctions and recoupment of Medicaid payments. Medicaid payments for services that lack required documentation or appropriate Date: Dec. Ol [2008 (title) Return completed acknowledgement statement to Medicaid Program Integrity. Corrective action plan -- Acknowledgement Statement Final Agency Audit Report March 21, 2008 C.1. 08-6722-000

Docket for Case No: 08-004893MPI