Apr 21 2009 10:38 APR-21-2689 14:51 AGENCY HEALTH CARE ADMIN 858 921 6158 P.@6 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2009002635 DOCTOR’S CHOICE HOME CARE, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, DOCTOR’S CHOICE HOME CARE, INC. (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2008), and alleges as follows: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of FIVE THOUSAND DOLLARS ($5,000.00) against a home health agency pursuant to Section 400.474(6), Florida Statutes (2008). JURISDICTION AND VENUE 1. This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). 2, The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2008); Chapters 408, Part II, and 400, Part III, Florida Statutes (2008), Apr 21 2009 10:38 APR-21-2089 14:51 AGENCY HEALTH CARE ADMIN 856 921 4158 , and Chapter 594-8, Florida Administrative Code, 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4, The Agency is the licensing and regulatory authority that oversees home health agencies and enforces the applicable federal and state statutes, regulations and rules governing hore health agencies. Chapter 408, Part If, and Chapter 400, Part III, Florida Statutes (2008), and Chapter 59A-8, Florida Administrative Code. The Agency is authorized to deny, revoke, or suspend 4 license, or impose an administrative fine for violations as provided for by Section 400.474, Florida Statutes (2008), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code. 5. The Respondent was issued a license by the Agency (License No. 299992834) to operate a home health agency located at 7250 8. Beneva Road, Sarasota, Florida 34238, and was at all material times required to comply with the applicable federal and state statutes, regulations and rules for home health agencies. COUNT I The Respondent Provided Remuneration To Physicians In Violation Of Section 400.474(6), Florida Statutes (2008) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). ) 7. Pursuant to Florida law, the agency may deny, revoke, or suspend the license of a home hea!th agency and shall impose a fine of $5,000 against a home health agency that: (a) Gives remuneration for staffing services to: 1. Another home health agency with which it has formal or informal patient- referral transactions or arrangements; or APR-21-2889 11:52 Apr 21 2009 10:39 AGENCY HEALTH CARE ADMIN 856 921 4158 2. A health services pool with which it has formal or informal patient-referral transactions or arrangements, unless the home health agency has activated its comprehensive emergency management plan in accordance with Section 400.492, Florida Statutes (2008). This paragraph does not apply to a Medicare-certified home health agency that provides fair market value remuneration for staffing services to a non-Medicare-certified home health agency that is part of a continuing care facility licensed under Chapter 651, Florida Statutes (2008) for providing services to its own residents if each resident receiving home health services pursuant to this arrangement attests in writing that he or she made a decision without influence from staff of the facility to select, from a list of Medicare-certified home health agencies provided by the facility, that Medicare-certified home health agency to provide the services. (b) Provides services to residents in an assisted living facility for which the home health agency does not receive fair market value remuneration. (c) Provides staffing to an assisted living facility for which the home health agency does not receive fair market value remuneration. (d) Fails to provide the Agency, upon request, with copies of all contracts with assisted living facilities which were executed within 5 years before the Tequest. (e) Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under Chapter 395, Florida Statutes (2008) or P.@8 APR-21-2889 11:52 ) Apr 21 2009 10:39 AGENCY HEALTH CARE ADMIN 856 921 4158 Chapter 400, Florida Statutes (2008), from whom the home health agency receives referrals. Fails to submit to the agency, within 15 days after the end of each calendar quarter, a written report that includes the following data based on data as it existed on the last day of the quarter: The number of insulin-dependent diabetic patients receiving insulin-injection services from the home health agency; The number of patients receiving both home health services from the home health agency and hospice services; The number of patients receiving home health services from that home health agency; and The names and license numbers of nurses whose primary job responsibility is to provide home health services to patients and who received remuneration from the home health agency in excess of $25,000 during the calendar quarter. (g) Gives cash, or its equivalent, to a Medicare or Medicaid beneficiary. (h) Has more than one medical director contract in effect at one time or more than @ 1. 2. one medical director contract and one contract with a physician-specialist “whose services are mandated for the home health agency in order to qualify to participate in a federal or state health care program at one time. Gives remuneration to a physician without a medical director contract being in effect. The contract must: Be in wiiting and signed by both parties; Provide for remuneration that is at fair market value for an hourly rate, which P.@9 Apr 21 2009 10:39 APR-21-2089 11:52 AGENCY HEALTH CARE ADMIN 856 921 4158 P.1a must be supported by invoices submitted by the medical director describing the work performed, the dates on which that work was performed, and the duration of that work; and 3. Be fora term of at least one (1) year. The hourly rate specified in the contract may not be increased during the term of the contract. The home health agency may not execute a subsequent contract with that physician which has an increased hourly rate and covers any portion of the term that was in the original contract. (j) Gives remuneration to: 1. A physician, and the home health agency is in violation of paragraph (h) or paragraph (1); | 2. A member of the physician’s office staff; or 3. An immediate family member of the physician, if the home health agency has received a patient referral in the preceding 12 months from that physician or physician's office staff. (k) Fails to provide to the Agency, upon request, copies of all contracts with a medical director which were executed within 5 years before the request. Section 400.474(6), Florida Statutes (2008). 8. On or about November 13, 2008 the Agency conducted a Complaint Survey (CCR# 208011401) of the Respondent’s facility. 9. Based on interview and review of facility documentation related to meals provided to physicians, the home health agency failed to ensure compliance with the rule related to remuneration to physicians and other referral sources. Apr 21 2009 10:40 APR-21-2889 11:53 AGENCY HEALTH CARE ADMIN 856 921 @158 Pidi 10, An interview with four (4) personnel identified by the home health agency administrative staff as those who deal with "Marketing" physicians was performed. This occurred between 9:15 a.m. and 10:00 a.m. on November 13, 2008. The interviewees stated they had been providing lunch and other goodies such as pens and notepads to physicians offices. They stated originally they had been doing it to their physicians that provided referrals, however, after July 1, 2008, they stopped providing any of this to any physician that had provided any referral to the agency. After July 1, 2008, they continued to provide lunches and other meals to physicians who had not given them a referral. The four (4) marketers indicated they had stopped doing this the beginning of October. 11. A review of information regarding expenditures by the home health agency related to marketing was performed. This was in a log form, indicating the date, the number of people involved, and what was provided including the costs. This review revealed the marketing personnel provided lunch, coffee, or dinner to physicians from July 2, 2008 until October 2, 2008. 12. During an interview with the two (2) vice presidents of operations on November 13, 2008 at 10:00 am., they stated they were aware of the new tules in July, but they were using information provided to them from the home health agency association, which indicated they could continue to provide food to physicians who had not referred to them as long as they stayed below $365.00 per year. They found out they could not do this during a big meeting they sponsored on October 3, 2008, at which time they stopped providing food to any physicians. 13. The Respondent’s act constituted a violation of Section 400.474(6), Flonda Statutes (2008) and the Agency shall impose a fine of five thousand dollars ($5,000.00) for the violation. Apr 21 2009 10:40 APR-21-2889 11:53 AGENCY HEALTH CARE ADMIN 856 921 @158 P.i2 14. The Respondent was given a mandatory correction date of December 13, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of FIVE THOUSAND DOLLARS ($5,000.00) pursuant to Section 400.474(6), Florida Statutes (2008). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent: 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of FIVE THOUSAND DOLLARS ($5,000.00). 3. Enter any other relief that this court deems just and appropriate. Respectfully submitted on this pfaz day of Ge xed 2009. Tethins J “pe Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Apr 21 2009 10:40 APR-21-2089 11:53 AGENCY HEALTH CARE ADMIN 856 921 4158 P.13 NOTICE THE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120,369 AND 120.57, FLORIDA STATUTES. IF THE RESPONDENT WANTS TO HIRE AN ATTORNEY, IT/HE/SHE HAS THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS FORM. THE RESPONDENT IS FURTHER NOTIFIED IF THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED, THE ELECTION. OF RIGHTS FORM SHALL BE MADE TO THE AGENCY FOR HEALTH CARE ADMINISTRATION AND DELIVERED TO; AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BUILDING 3, MAIL STOP 3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (830) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form have been served to: Janet Harrison, Administrator, Doctor’s Choice Home Care, Inc., 7250 §. Beneva Road, Sarasota, Florida 34238, United States Certified Mail, Return Receipt No. 7008 1140 0003 8889 7464, and to Tim Beach, Registered Agent for Doctor’s Choice Home Care, Inc., 7250 Beneva Road, Sarasota, Florida 34238, United States Certified Mail, Retum Receipt No. 7008 1140 0003 8889 7471 on this aha day of gorcls , 2009. MesMriey iy fic Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 APR-21-2089 11:53 Copies furnished to: AGENCY HEALTH CARE ADMIN Apr 21 2009 10:41 856 921 4158 Janet Harrison, Administrator 7250 §, Beneva Road Sarasota, Florida 34238 (U.S. Certified Mail) Doctor’s Choice Home Care, Inc. Mary Daley Jacobs Assistant General Counsel Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) Tim Beach, Registered Agent for 7250 Beneva Road Sarasota, Florida 34238 (U. S. Certified Mail) Doctor’s Choice Home Care, Inc. Harold Williams Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) P.14 Apr 21 2009 10:41 APR-21-2089 11:54 AGENCY HEALTH CARE ADMIN 856 921 4158 P.is SENDER: COMPLETE TRIS SECTION @ Complete items 1, 2, and.3, Also complete Item 4 if Restricted Delivery fs desired, ® Print your name and addres on the reverse 80 that we can return the card to you, B Attach this card to the back of the mallplece, or on the front If epace permits. d 4, Articla Addressed to: 200900263 Jan efF Ha rise, Adlerinis footer! Dacter's Chace Home Care, {ne 7250 S. Beneva Road Sarasota, Flondsa: 34238 "D. isdelvery address different trom tem 17 1 Yea ICYES, enter delivery addrasa below: =. No 3, Service Type |, Ch Gantted Mat express Mall OO Registered T] Retum Receipt for Merchandles Ol ingured Mall == 1.6.0.0. 4, Restricted Delivery? (Extra Fee) 2. Article Number aaa woe (ranster from servicalabs) 7008 1140 0003 8884 74b4 . Ps Form 3811, February 2004 Domestic Retum Receipt 102555-02-N-1540 TOTAL P.15

Docket for Case No: 09-002132