STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

GREGORY CHRISHON, )

)

Petitioner, )

)

vs. ) CASE NO. 87-1486

) DEPARTMENT OF ADMINISTRATION, ) OFFICE OF STATE EMPLOYEES' ) INSURANCE, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice this cause came on for formal hearing before P. Michael Ruff, a duly designated Hearing Officer, in DeFuniak Springs, Florida, on October 29, 1987. The appearances were as follows:

APPEARANCES

For Petitioner: T. Patterson Maney, Esquire, P.A.

123 Staff Drive

Post Office Drawer 1628

Fort Walton Beach, Florida 32549

Far Respondent: Andrea R. Bateman, Esquire

Assistant General Counsel Department of Administration

435 Carlton Building Tallahassee, Florida 32399-1550

BACKGROUND

This cause arose upon notification by the above-named agency to Mr.

Chrishon that he would be required to reimburse the Department of Administration for $1,920 due to an alleged erroneous duplicate payment made to him by Blue Cross/Blue Shield related to the purchase of an "EBI bone healing system." Mr. Chrishon was a state employee formerly covered by the State Group Health Self- Insurance Plan and, as a result of an accident or injury, had obtained that equipment for which the provider, EBI, allegedly received payment in the approximate amount of $2,000. It is alleged that some $1,920, constituting duplicate reimbursement, was also paid the petitioner, which he was not entitled to retain pursuant to Chapter 3A-21, Florida Administrative Code. Specifically, the Department is seeking reimbursement of the alleged $1,920 overpayment in accordance with Rule 3A-21.04(2), Florida Administrative Code, by which the Department may seek involuntary wage reductions, in the absence of an agreement as to voluntary payment or deduction from wages, for any such over-reimbursement of medical insurance benefits.

The matter came on for formal hearing as noticed, and at the outset of the hearing, the parties elected to confer and ultimately entered into a stipulation as to facts and law. They agreed nevertheless to submit the stipulation to the Hearing Officer for Recommended Order in accordance with Section 120.57, Florida Statutes. The issue to be resolved concerns whether the petitioner, Mr.

Chrishon, received an overpayment related to the purchase of the EBI equipment in question, in the amount of $1,920, and whether that sum should be remitted to the State of Florida Employees Health Self-Insurance Plan.

FINDINGS OF FACT

The parties have stipulated to the following facts:

1. The petitioner received payment of $1,920 from Blue Cross/Blue Shield for the purchase of an EBI bone healing system.

   
   

2. Blue Cross/Blue Shield also paid $2,000 to EBI Medical Systems, Inc., the provider, for the purchase of the same equipment.

   
   

3. The petitioner was not covered by his state health insurance plan at the time of the purchase of the equipment, because he had failed to pay his premiums while he was on leave without pay from his state employment position.

   
   

4. The petitioner has not remitted payment for the purchase of the EBI equipment to the respondent agency.

   
   

5. The petitioner owes the State of Florida the sum of $1,920.

   
   

   CONCLUSIONS OF LAW

   
   

6. The petitioner, Gregory Chrishon, received an overpayment related to the purchase of the EBI equipment at issue, in the amount of $1,920. He is required to remit that amount to the State of Florida Employees Health Self- Insurance Plan in accordance with Chapter 3A-21, Florida Administrative Code. The petitioner agrees to pay the amount in question to the respondent in accordance with a payment schedule which will be negotiated between the respondent and the petitioner. That payment will constitute the total amount due to the respondent arising out of the claim for reimbursement for services received related to the purchase of the EBI equipment by petitioner, for which the petitioner received the above sum. Such a voluntary repayment schedule or agreement is countenanced by Rule 3A-21.04(2), Florida Administrative Code, and the parties have agreed to such a procedure in settlement of this claim.

   
   

7. The respondent in turn will not be prohibited from proceeding against any other person or business entity for sums erroneously paid for the subject equipment, in view of the stipulated fact that the petitioner was not covered by his state health insurance plan for failure to pay premiums at the time of the purchase of the equipment.

RECOMMENDATION

In consideration of the foregoing findings of fact and conclusions of law, it is

RECOMMENDED that a Final Order be entered by the Department of Administration requiring that the petitioner, Gregory Chrishon, pay the Department of Administration, Office of State Employees' Insurance, the sum of

$1,920 in accordance with a payment schedule to be agreed upon by the respondent and the petitioner, and to provide that such payment will constitute the total amount due to the respondent from the petitioner arising out of the claim for reimbursement for services received related to the purchase of the subject equipment.

DONE and ENTERED this 23rd day of December, 1987, in Tallahassee, Leon County, Florida.

P. MICHAEL RUFF Hearing Officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 23rd day of December, 1987.

COPIES FURNISHED:

T. Patterson Maney, Esquire, P.A.

123 Staff Drive

Post Office Drawer 1628 Fort Walton Beach, Florida

32549 Andrea R. Bateman, Esquire Assistant General Counsel Department of Administration

435 Carlton Building Tallahassee, Florida 32399-1550

Adis M. Vila, Secretary Department of Administration

435 Carlton Building Tallahassee, Florida 32399-1550

Docket for Case No: 87-001486

Orders for Case No: 87-001486