+ STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS MARTA S. GARCIA-LAVIN, Petitioner, Mm: chee vs. CASE NO. 99-4152 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THIS CAUSE is before me for issuance of a Final Order. In a Final Agency Audit Report dated May 19, 1999, Marta Garcia-Lavin, M.D. (Petitioner) was informed that the State of Florida, Agency for Health Care Administration (Agency) was seeking to recoup Medicaid overpayments in the amount of $78,453.68. A formal administrative hearing was held on December 13 and 14, 2001 before Administrative Law Judge Michael Parrish. The Petitioner was terminally ill at the time of hearing and she passed away on September 3, 2002, prior to the parties proposed recommended orders being filed with the Division of Administrative Hearings. An Order Closing File rendering the case moot was entered on January 29, 2003. The above-styled matter is now moot and there is no other issue pending. je Based on the foregoing, the request for a hearing is dismissed and the file is CLOSED. DONE and ORDERED on Ochi U1 2003, in Tallahassee, Florida. 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: L. William Porter II Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Joann Garone 2342 N.W. 187 Avenue Pembroke Pines, Florida 33029 (U.S. Mail) Mariano R. Gonzalez, Esquire 15600 N.W. 67 Avenue, Suite 308 Miami Lakes, Florida 33014 (U.S. Mail) Michael Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Bonnie Mils Pefera, Medicaid Program Integrity Willie Bivens, Finance & Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above-named addressees by U.S. Mail on , 2003. ree esl sag eealy” (JO ngency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 @ e STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS MARTA S. GARCIA-LAVIN, Petitioner, vs. CASE NO. 99-4152 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SUGGESTION OF DEATH Respondent, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, suggests the death of Defendant that occurred on September 3, 2002. Respectfully submitted on this the 2 OQ day of April 2000. {Wella rts L. WILLIAM PORTER Il, ESQUIRE Assistant General Counsel Florida Bar I.D. No. 0648914 Texas Bar ID. No. 00793196 Agency for Health Care Administration 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308-5403 (850) 922-5873 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing document has been furnished by U.S. Mail to: Joanne Garone, Esquire, 2342 N.W. 187 Avenue, Pembroke Pines, Ds Florida 33029 on this RO day of September 2002. Wtlw Ai — PORTER I, ESQUIRE iar la mafana de el 3 de jembre del 2002 despues de ua larga fafo 1960 de la Escuela de Medicina del Na Universidad de 1a Havana, Vino a vi Wir a los Estados Unidos ene glar pho 196 1962; 4§.e sobreviven su aLaviny a octor Carlos Garcia y sus 5 os jarta, Lourdes, Carlos, Silvia y La us 3 nietos Jonathon, Victoria yCarlit ‘su nueza Dawn yyerno Jai. ‘odo aque! Que Ia conocio la extra. tara p por siempre: ‘Su cuero fue expuest kl Tmlercoles en Ja funeraria Bernard Garcia. Sellevara dca una isa en honor en la iglesia Thomas stle Catholic Church al a jacves 7 SW St. a las 12 del mreitio ¢| tiembre, 2 Bn lu dee flores se a Deacit alaligac contrac el = ‘0 visi Hans one ke FEB-12-2083 13:29 MEDICAID PROGRAM INT 385 4786795 P.@2 *JUN.25. 45 eet PRM PRYOR artimies: - of STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 42D BUSH, GOVERNOR RUBEN J. KING-BHAW, JR, DIRECTOR May 19, 1999 CERTIFIND MAIL - RETURN RECEIPT No. Z 11¢ 600 660 Provider No. 0585444 00 Marta Garcia-Levin . 13645 sw 26 cereet Miami, Florida 33175 In Reply Refer to FINAL AGENCY AUDIT REPORT C.I. 96-1900-~-000 ; Dear Provider: The Agency for Health; Care. Administration, Madicaid Program Intagrity office hax completed the review of your Medicaid claims =Or the procedures Specified below fer dates of bervioe during the Period November 15, 1887, through January 15, 1999. A provimional agency audit 1999, was sent to you ; indicating you ware Overpaid $78,453.68. We have ceceived your Tesponse regarding the Provisional lctter. You hava Tailed to present any reason or 5s would change your Situation, Therefore, it has been Getermined that pou were overpaia $78,453.68 for @ or in part are not Govered by Medicaia. 7 In determining PayMent pursuant te Mediceid policy, . program utisizes procedure codes. dascri limitations’ ang exclusions found in the Medicaid provider handbooks and section 409.513, F.S. tn applying for Medicaid reimbursement, Providers are required to follow the guidelines set forth in che Gicaid fee achedulea, «s Promigared in the Meedieaid cannot O not meat these guidelines. TALLAHASSES, FL 34308 SS Se oe; ; FEB-12-2083 13:29 MEDICAID PROGRAM INT 385 4786795 P.@3 a net ' Marta Garcia-Lavin Page 2 Below is a discussion of the particular guidelines related to our review of your claims and an explanation of why these claims do not meet Medicaid requirements. An attached computer printout liats the claims that are affected by thie determination. REVIEW DETERMINATIONS The following review determinations were made by applying Medicaid policy to the medical record documentation provided by your office at the request of the Agency for Health Care Administration, Medicaid Program Integrity. Medicaid policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. The documentation you provided Supports a lower level of office visit than the one for which you billed and received payment. The difference between the amount you were paid and the correct payment for the appropriate level of service is considered an overpayment. Medicaid policy requires that payments be made only for those services listed in the provider handbook. You billed and received payment for services that, when reviewed by a physician consultant, indicated that the service was not -Medicaid covered. Payments made-to you for these services are considered overpayments. -. Medicaid policy requires services performed be medically necessary for the diagnosis and treatment of an illness. You billed and received payments for services for which the medical records, when reviewed by a Medicaid physician consultant, indicated that the services provided did not meet the Medicaid criteria for medical necessity. The claims, which were considered medically unnecessary, were disallowed and the money you were paid for these procedures is considered an overpayment. If you have any questions about this matter, contact Bonnie Mills-— Herrera, Medical Health Care Program Analyst, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, P.O. Box 52-2804, Miami, Florida 33152-26804, telephone (305) 470-5862. 2727 MAHAN DRIVE - TALLAHASSEE, FL 32308 sys $n hh anatase pec: FEB-12-20@3 13:29 MEDICAID PROGRAM INT 3@5 4726795 P.84 Marta Garcia-Lavin Page 3 If you concur with the amount of the overpayment, send your check for $78,453.68. The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the agency. To ensure proper credit, be certain your provider number is shown on your check. Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable P.O, Box 13749 Tallahessee, Florida 32317-3749 If payment is not received within twenty-one (21) days of the date of receipt of this letter, the Agency for Health Care Administration will withhold Medicaid payments in accordance with the provisions of section 409.913, F.S., until the amount owed is fully recovered. Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts receivable, (850) 921-4396. You have the right to request a formal or informal hearing pursuant to Section 120.57, Florida Statutes. If a petition for formal hearing is made, the petition must be made in compliance with rule section 28-5.201, Florida Administrative Code. Please note that rule section 28-5.201(2) specifies that the petition shall contain a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty~one (21) days of receipt of this letter, and failure to timely request a hearing shall be deemed a waiver of your right to a hearing. It is important that a request for an informal hearing or a petition for a formal hearing be sent only to the following address: Mr. Edward W. Turner, Chief Medicaid Program Integrity State Health Purchasing Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308-5403 Do not send requests or petitions to any other address. If a hearing request is not received within twenty-one (21) days from the date of receipt of this letter, the right to such hearing is waived, and repayment of the above stipulated overpayment will be due and payable at the end of that twenty-one (21) day peried. 2727 MAHAN DRIVE 5) TALLAHASSEE, FL 32305 FEB-1 2-2083 13 38 _ MEDICAID PROGRAM INT . 385 4786795 _ PBS Marta Garcia-Lavin Page ¢ if a timely hearing reqest {s not received, if dt is received and subsequently withdxawn by you, and repayment is not made by that time, an interest penalty of ten percent (10%) a year from the date of this final ageney action shall be imposed in aceordanca with the provisions of section 409.913, F.s. Sincerely, lo. A Edward W. Turner, Chief Medicaid Program Integrity EWT: BMH: def Encloaures ce: Medicaid Accounts Receivable Medicaid Program Development - -.. Madicaid Program: Integrity Aditinistration Medicaid Program: Integrity Work Group Five Area Medicaid Office 2727 MAHAN DRIVE TALLAHASSZE, FL 323508 TOTAL P.@5

Docket for Case No: 99-004152MPI