STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

BILLY BEEKS, M.D., )

)

Petitioner, )

)

vs. ) CASE NO. 96-0297

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Claude B. Arrington, held a formal hearing in the above-styled case on April 17, 1996, in Miami, Florida.

APPEARANCES

For Petitioner: Billy Beeks, M.D.

8401 North Miami Avenue Miami, Florida 33138

For Respondent: Karel Baarslag, Esquire

Agency for Health Care Administration Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403 STATEMENT OF THE ISSUES

Whether Respondent correctly recalculated the amount by which Petitioner was overpaid by the Florida Medicaid program.

PRELIMINARY STATEMENT

On October 19, 1995, the Agency for Health Care Administration entered a final order in DOAH Case 94-1365 which adopted the findings of fact and conclusions of law contained in the Recommended Order entered by the undersigned in that proceeding. That Recommended Order contained detailed findings as to billings to the Medicaid program submitted by Dr. Beeks and concluded that Dr.

Beeks had been overpaid by the Medicaid program. It was recommended that AHCA recalculate the amount of the overpayment based on the findings of fact contained in the Recommended Order. The Final Order provided, in pertinent part, that ". . . [t]he dollar amount of the overpayment liability shall be calculated based on the findings and conclusions made by the hearing officer. Should factual disputes arise on the basis of the calculation of the dollar amount of the liability, a motion to reopen this case shall be entertained." Dr. Beeks challenged the amount of the recalculation. The matter was referred to the Division of Administrative Hearings, and this proceeding followed.

At the formal hearing, AHCA presented the testimony of two of its employees who participated in the recalculation and presented two exhibits, both of which were admitted into evidence. Dr. Beeks presented no witness, but he introduced two exhibits, both of which were admitted into evidence.

No transcript of the proceedings has been filed. Neither party submitted a post-hearing submittal.

FINDINGS OF FACT

1. On August 23, 1995, the undersigned entered a Recommended Order in DOAH Case 94-1365. The Petitioner in that proceeding was Billy Beeks, M.D., and the Respondent was the Agency for Health Care Administration (AHCA). At issue in that proceeding was whether Dr. Beeks had been overpaid by the Medicaid program. The Recommended Order contained extensive findings of fact, including findings as to the appropriate levels at which certain services should have been billed to the Medicaid program by Dr. Beeks. It was concluded that because certain of his services were billed at levels higher than justified by Medicaid protocol, Dr. Beeks had been overpaid by the Medicaid program. Because the calculation of such overpayments are done by computer, it was recommended that the overpayment be recalculated based on the findings of fact contained in the Recommended Order.

   
   

2. On October 19, 1995, Douglas M. Cook, Director of AHCA, entered a Final Order in DOAH Case 94-1365. That Final Order adopted the findings of fact and conclusions of law contained in the Recommended Order and provided, in pertinent part, as follows:

   
   

   The dollar amount of the overpayment liability shall be calculated based on the findings and conclusions made by the hearing officer.

   
   

3. The amount of the overpayment claimed by AHCA at the beginning of the hearing in DOAH Case 94-1365 was $50,852.56.

   
   

4. An overpayment to Medicaid is calculated by computer using a statistical analysis of a sampling of the provider's billings to Medicaid. AHCA asserted that the level at which Dr. Beeks had billed Medicaid for certain of these services in the sample was excessive. It was found in that underlying proceeding that while Dr. Beeks had billed certain of his services at excessive levels as asserted by AHCA, some of the challenged billings were not excessive and others were not as excessive as asserted by AHCA. Logically, one would expect that the recalculation of overpayment would result in a smaller figure than that claimed prior to the hearing.

   
   

5. Following the entry of the Final Order, Vickie Givens, an employee of AHCA, made a detailed analysis of the evidence presented at the formal hearing, including the deposition of Joni Leterman, M.D.. Ms. Givens compared her analysis with the findings of fact contained in the Recommended Order and discovered certain billings by Dr. Beeks that she believed should have been included in the Recommended Order as being excessive. 1/ These billings were not included in the Recommended Order and, consequently, were not incorporated by reference into the Final Order.

   
   

6. Thereafter the overpayment was recalculated by an appropriately trained AHCA employee. As instructed, this employee included in the recalculation of

   the overpayment the additional billings for the services identified by Ms. Givens, but not included in the Recommended Order.

   
   

7. AHCA staff recalculated the amount of the overpayment to Dr. Beeks to be $51,745.13, which is slightly higher than the amount claimed prior to the hearing in DOAH Case NO. 94-1365. The figure that resulted from this recalculation was higher than it would have been had these additional billings not been included.

   
   

   CONCLUSIONS OF LAW

   
   

8. The Division of Administrative Hearings has jurisdiction of the subject matter of and the parties to this proceeding. Section 120.57(1), Florida Statutes.

   
   

9. Section 409.913(9), Florida Statutes, authorizes AHCA to seek reimbursement when a provider has been overpaid by the Medicaid program.

   
   

10. The Final Order entered in this proceeding ordered AHCA to recalculate the overpayment to Dr. Beeks based on the findings of fact contained in the Recommended Order. AHCA did not follow this order and, consequently, the resulting recalculation of the overpayment was flawed.

    
    

11. Because the recalculation can only be done by computer, with trained personnel, it will be necessary for AHCA to again recalculate the amount of the overpayment. That recalculation should be based solely on the findings of fact contained in the Recommended Order in DOAH Case 94-1365 and adopted by the agency's final order.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency enter a final order that adopts the findings of

fact and conclusions of law contained herein and that the Agency recalculate the

total amount of the overpayment during the audit period based solely on the findings of fact contained in the Recommended Order in DOAH Case 94-1365.

DONE AND ENTERED this 8th day of July, 1996, in Tallahassee, Leon County, Florida.

CLAUDE B. ARRINGTON, Hearing Officer Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 8th day of July, 1996.

ENDNOTE

1/ Agency Exhibit One was prepared by Ms. Givens based on her analysis. The billings that she believed should have been included in the Recommended Order are those in the column "Hearing Officer's Order" with the notation "not in final order" or "nothing in final order".

COPIES FURNISHED:

Billy Beeks, M.D. 8401 N. Miami Avenue Miami, Florida 33138

Karel Baarslag, Esquire

Agency for Health Care Administration Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403

Sam Power, Agency Clerk

Agency for Health Care Administration Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403

Jerome W. Hoffman, General Counsel Agency for Health Care Administration Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions to this recommended order. All agencies allow each party at least ten days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the final order in this case concerning agency rules on the deadline for filing exceptions to this recommended order. Any exceptions to this recommended order should be filed with the agency that will issue the final order in this case.

Docket for Case No: 96-000297

Orders for Case No: 96-000297