Lge STATE OF FLORIDA "pee 4 AGENCY FOR HEALTH CARE ADMINISTRATION __ ® ¥ DE NOEL A. PACHECO d/b/a COMPLETE MEDICAL, =" Petitioner, vs. " DOAH CASE NO. 00-3570 Audit C.I. No. 98-0971-000 oe in Provider No. 380941200 uo © RENDITION NO.: AHCA-00- 27 -S-MDO AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement on November 16, 2000, which is incorporated by reference. The parties are directed to comply with the terms of the settlement. Based on the foregoing, this file is CLOSED. . th DONE AND ORDERED on this the J = day of (scene Gare 2000, in Tallahassee, Florida. Ruben J sala Jr., Secretary Agency for Health Care Administration 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: Artice L. McGraw, Esquire 817 North Palafox Street Pensacola, Florida 32501 ‘Heidi Hughes, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Barbara J. Staros Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 John Owens, Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 Finance & Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been ished to the above named addresses by U.S. Mail on this the , 2000. R.S. Power, Agen€y Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5865 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS NOEL A. PACHECO d/b/a COMPLETE MEDICAL, Petitioner, vs. Case No. 00-3570 Provider No. 380941200 C.1. No. 98-0971-000 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION ("AHCA" or "the Agency"), and NOEL A. PACHECO d/b/a COMPLETE MEDICAL ("PROVIDER"), by and through the undersigned, hereby stipulate and agree as follows: 1. This Agreement is entered into between the parties to resolve issues of Petitioner's compliance with Chapter 409, Florida Statutes, and the Medicaid Provider Handbook. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. By letter dated July 5, 2000, AHCA notified the PROVIDER that a Preliminary Agency Audit of Medicaid billings indicated an overpayment from the Medicaid Program in the amount of $21,172.63 for the period January 1, 1997 through December 31, 1998. Page 1 of 6 4. In order to resolve this matter without further administrative proceedings, the PROVIDER and AHCA expressly agree as follows: a.) AHCA agrees to accept the payment set forth herein in full and complete settlement of the overpayment issues uncovered by the above-referenced audit, and agrees not to impose any fines or penalties arising from Medicaid billings for the period January 1, 1997 through December 31, 1998. b.) AHCA agrees not to terminate the PROVIDER as a Provider for the overpayments uncovered by the audit so long as PROVIDER complies with this Agreement, and continues to comply with all Florida Statutes, Medicaid Rules and all other applicable rules, regulations and policies. c.) PROVIDER agrees to pay the Agency the total sum of seventeen thousand dollars ($17,000.00) plus ten percent interest, in eighteen monthly installments of one thousand, twenty dollars and ninety-seven cents ($1,020.97) due on the first day of each month beginning November 1, 2000 and continuing until payment in full. An amortization schedule is attached hereto and incorporated herein by reference. 5. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 31317-3749 6. Upon full payment to the Agency of the amount provided in paragraph four (4), the Agency hereby agrees to release the Provider from any and all liability arising from the findings in the audit of Medicaid billings for the period of January 1, 1997 through December 31, Page 2 of 6 1998 (C.I. No. 98-0971-000) as set forth in the Agency's preliminary audit letter dated July 5, 2000, incorporated herein by reference. 7. In the event that PROVIDER fails to make any payment due hereunder, the Agency may, at its option and upon fifteen days written notice to PROVIDER, deem PROVIDER in default. If PROVIDER fails to remit all payments due within ten days after receipt of the notice, PROVIDER shall be in default and the full outstanding balance specified in paragraph 4 (c) shall be due and payable. PROVIDER’S participation in the Medicaid program shall be suspended until such time as the Agency receives payment of the balance in full. Nothing in this Agreement shall be construed to limit in any way the ability of the AGENCY to terminate PROVIDER pursuant to Section 409.907(2), F.S. (1999). Notwithstanding the foregoing, the AGENCY agrees not to terminate PROVIDER based on findings in the instant audit so long as PROVIDER complies with this Agreement. However, if PROVIDER fails to cure its default hereunder within ten (10) days of written notice, PROVIDER understands and agrees that the Agency may exercise its option to terminate PROVIDER from the Medicaid program. 8. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 9. Each party to the Agreement shall bear its own attorneys fees and costs, if any. 10. The signatories to this agreement acknowledge that they are duly authorized to enter into this Agreement on behalf of the respective parties. 11. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida. 12. In the event that a party breaches this Agreement, and enforcement of this Page 3 of 6 Agreement or recovery of damages for breach hereof is obtained by law or by legal proceedings through an attorney at law, all costs of collection or enforcement, including reasonable attomey's fees shall be paid by the breaching party to the nonbreaching party. 13. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between PROVIDER and the AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties. 14.‘ This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions, as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 15. | PROVIDER expressly waives in this matter its right to any hearing pursuant to Sections 120.569 or 120.57, Florida Statutes, the making or findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or rules of the Agency regarding this proceeding and any and all issues raised by the audit of Medicaid billing for the period of January 1, 1997 through December 31, 1998 (C.I. #98-0971- 000). PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal, except to enforce the obligations of the AGENCY under this Agreement. Page 4 of 6 16. | This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it. 17. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. 18. This Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. Page 5 of 6 ra ce “Dated: / 2 L4 q , 2000 Ca “Basheos d/b/a ‘ mpleéte | Medical FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Ft. Knox Bldg. #3 Tallahassee, FL 32308-5403 Ke Dated: () [1 ef 20~_, 2000 Rufus N@ple Inspector General N Dated: [ 1; / / , 2000 e Gallagher Dated: ZY TIE , 2000 Assistant General Counsel Page 6 of 6 AGENCY FOR HEALTH CARE ADMINISTRATION AMORTIZATION SCHEDULE Complete Medical-Noel Pacheco/Provider # 3809412-00/C. I. # 98-0971-000 Past Due Balance:|$17,000.00 Table starts at date: Annual int rate:| 10.00% or payment number: 1 Term in years:|1.5 Payments per year:|12 First payment due:|11/01/2000 CALCULATED PAYMENT Entered payment: Calculated payment:|$1,020.97 Monthly Pmt Used: |$1,020.97 $17,000.00 1st Pmt in Table: 1 payment 1: $0.00 Table Cumulative interest prior to Payment Beginning Cumulative Payment Date Due Date Balance p Interest Amount Paid 11/01/2000 17,000.00 141.67 879.30 16,120.70 141.67 | 1,020.97 [ 12/01/2000 16,120.70 134.34 886.63 15,234.07 276.01 | 1,020.97 [| 01/01/2001 15,234.07 126.95 894.02 14,340.05 402.96 | 102097 [ 02/01/2001 14,340.05 119.50 901.47 13,438.58 522.46 | 1,020.97 [ | 3 | 03/01/2001 13,438.58 111.99 908.98 12,529.59 634.44 [1,020.97 | ssi 04/01/2001 12,529.59 104.41 916.56 11,613.04 738.86 | 1,020.97 [ 7 05/01/2001 11,613.04 96.78 924.19 10,688.84 835.63 | 1,020.97 [ 8 06/01/2001 10,688.84 89.07 931.90 9,756.95 924.71 | 1,020.97 [{ si 9 07/01/2001 9,756.95 81.31 939.66 8,817.29 4,006.02 1,020.97 | — 10 | 08/01/2001 8,817.29 73.48 947.49 7,869.79 1,079.49 1,020.97 | — | 11; 09/01/2001 7,869.79 65.58 955.39 6,914.40 1,145.07 [| 1,020.97 [ 12 | 10/01/2001 6,914.40 57.62 963.35 5,951.05 1,202.69 | 1,02097 [ | 13 | 11/01/2001 5,951.05 49.59 971.38 4,979.68 1,252.29 | 102097 [ 14 | 12/01/2001 4,979.68 41.50 979.47 4,000.20 1,293.78 | 102097 [| 15 | 01/01/2002 4,000.20 33.34 987.63 3,012.57 1,327.12 | 102097 [ sf 16 | 02/01/2002 3,012.57 25.10 995.87 2,016.70 1,352.22 | 1,02097 [ 17 | 03/01/2002 2,016.70 16.81 1,004.16 1,012.54 1,369.03 | 102097 [ 18 | 04/01/2002 1,012.54 8.44 1,012.53 0.01 1,377.47 102097 [| Ss [0.007 | CS Page 1 of 1

Docket for Case No: 00-003570