STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION WINTER HAVEN HOSPITAL, INC., Petitioner, vs. CASE NOS. 96-0370 We dA 96-4604 Chude AGENCY FOR HEALTH CARE HR 93-099 ADMINISTRATION, HR 94-108 Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a “settlement agreement”, which is incorporated by reference. The parties are directed to comply with the terms of the “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the [yt day of Novem ber , 2001, in Tallahassee, Florida. Rhonda M. Medows, MD, FAAFP, Secretary Agency for Health Care Administration act are pomeneprermeme wmmepss gpee cas ow eee 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: W. David Watkins, Esq. Watkins & Caleen, P.A. 1725 Mahan Drive, Suite 201 Tallahassee, Florida 32317-5828 Kim A. Kellum, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 William R. Cave Administrative Law Judge Division of Administrative Hearings The DeSoto Building : 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance. and Accounting Robert Maryanski, Medicaid Program Development IE Ere cs oe ee gee oe ar cop penn cemerpes: eg eepemeer -qertpe oye orem foregoing has been furnished coe the above named addressees CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the by U.S. Mail,on this the Left day of 2001. oF intetoLice maw Diane Grubbs, Esquire — 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 AGENCY FOR HEALTH CARE ADMINISTRATION WINTER HAVEN HOSPITAL, INC., Petitioner, vs. DOAH Case Nos. 96-0370 96-4604 HR 93-099 STATE OF FLORIDA, AGENCY HR 94-108 FOR HEALTH CARE ADMINISTRATION, ; Respondent. / SETTLEMENT AGREEMENT Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, Winter Haven Hospital, Inc., by and through the undersigned individuals, hereby stipulate and agree as follows: 1. This settlement agreement is entered into between the parties in order to resolve disputes that arose as the result of KePRO reviews. 2. Ina final agency audit letter dated December 6, 1995, Petitioner was informed that the Agency did not believe that it was medically necessary to admit certain patients. Consequently, Respondent sought recoupment in the amount of $118,049.12. A copy of the recoupment letter is attached to this agreement. DOAH Case number 96-0370. (HR 93-099) opener oe Evy 3. Ina petition dated January 2, 1996, Petitioner challenged Respondent’s action and requested a formal hearing. Jurisdiction was relinquished to AHCA at the request of the Parties. "4, In a final agency audit letter date August 8, 1996, Petitioner was informed that the Agency did not believe that it was medically necessary to admit certain patients. Consequently, Respondent sought recoupment in the amount of $93,681.66. A copy of the recoupment letter is attached to this agreement. DOAH Case number 96-4604. (HR 94-108) 5. In a petition dated August 28, 1996, Petitioner challenged Respondent's action and requested a formal hearing. Jurisdiction was relinquished to AHCA at the request of the Parties. 6. Subsequently, Respondent reviewed the admission of the patients in question. After this subsequent review and settlement negotiations, Respondent believes that Petitioner correctly admitted some of the patients identified in its audit letter. : : . 5. Accordingly, Respondent no longer contends that Petitioner owes Respondent $118,049.12 for case number 96- 0370 and $93,681.66 for case number 96-4604. It is therefore proper for these two cases to be settled with a combined total payment of $20,000 from Petitioner. 6. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable CORPS Toor ocr gee pr eee oe ee oR eee oe RR ric ramen eee cmemeer eer moe ee et at al Mccad CO age nor RCE err me oe wl Post Office Box 13749 Tallahassee, FL 32317-3749 7. Petitioner agrees to make payment to the Respondent upon entry of the Final Order incorporating the Settlement Agreement and agrees to pay the entire balance within sixty (60) days after the entry of the Final Order. 8. In the event the Petitioner fails to make any _ payment due hereunder, the Respondent may, at its option and upon fifteen days written notice to Petitioner, declare Petitioner in default. Its provider number shall be suspended until such time as the Agency receives payment of the balance in full. 9. This settlement does not constitute an admission of wrongdoing or error by either party. However, the parties believe that this matter should be settled. 10. Both parties request that the Agency close the file in this case. 11. Each party shall bear its own attorney’s fees and costs. 12. This agreement represents the entire agreement between the Parties regarding settlement of this case. No modification or waiver of any provision shall be valid selina unless a .written amendment to the. agreement is completed and properly. executed by the parties. ‘The signatories to this agreement, acting ina representative capacity, represent that they are duly authorized to act on behalf of the REC TOS OMRRIERET UhRETTOTERT WORDNET CPTI HOTT EIR ’“T9E FEE rr et panne an ee a en ae ee ree opreprrr es parties to the agreement. Venue for any action arising from this agreement shall be in Leon County, Florida. Dated this 1a day of Wo Ver bee~. of 2001. AGENCY FOR HEALTH CARE ADMINISTRATIO Ly William H. Roberts, Acting General Counsel State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Building #3 Tallahassee, Florida 32308 Robert Sharpe,- Director of Medicaid. State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Building #3 Tallahassee, Florida 32308 VEN HOSP Hospital Administrator Winter Haven Hospital 200 Avenue F, NE Winter Watkins & Caleen, P.A. 1725 Mahan Drive, Suite 201 Tallahassee, FL 32317-5828 cc: Robert Maryanski, Medicaid Program Development a OO sl ee ed

Docket for Case No: 96-000370