rN Sted Of. STATE OF FLORIDA o7 Ep f 5 D AGENCY FOR HEALTH CARE ADMINISTRATION ,. _. “Sepy 2 Apllvie, EUR Al a, "$3 LAKELAND REGIONAL MEDICAL M ey 1 CENTER, Petitioner, Co vs. Case No. 00-4210 W b STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER The Petitioner, Lakeland Regional Medical Center challenged the Agency for Health Care Administration’s (Agency) intent to seek a refund of Medicaid overpayments totaling $2,771.22. Lakeland Regional Medical Center’s request for formal administrative hearing was referred to the Divisions of Administrative Hearings (Division). Subsequently, Lakeland Regional Medical Center withdrew its request for a hearing. Based on Lakeland Regional Medical Center's ’voluntary dismissal the assigned administrative law judge (ALJ) closed the Division’s file. The ALJ’s “Order Closing File” dated October 25, 2000 is incorporated by reference. The factual basis for the intended refund decision is stated in the Agency’s audit letter. . Based on the foregoing, the factual basis for the intended refund decision is deemed admitted. Accordingly, Lakeland Regional Medical Center is directed to refund $2,771.22 by check payable to the Agency for Health Care Administration. Payment in full of the refund has been received. Based on the foregoing, the request for a hearing is dismissed and the file is CLOSED. DONE and ORDERED on this the QO day of , 2001, in Tallahassee, Florida. Perv pee J. King-Shaw, 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: Kim A. Kellum, Esquire Senior Attorney Agency for Health Care Administration (Interoffice Mail) Michelle R. Surrency, CQAUR PRO Liaison Lakeland Regional Medical Center Post Office Box 95448 Lakeland, Florida 33804 William R. Cave Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 John Owens, Chief, 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 this the Dray of __¢ , 2001. .S. Powér, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865

Docket for Case No: 00-004210