RECEIVED may 03 2002 AUDIT SERVICES = See ee ee STATE OF FLORIDA eer AGENCY FOR HEALTH CARE ADMINISTRATION *~' ‘3 > 4 ARCADIA HEALTHCARE, LLC, Se = ay d/b/a Dove Healthcare at mASs ° Lake Wales, Ba © _ 7 Za py i Petitioner, Ox, =x ae) vs. ~ Case No. STATE OF FLORIDA, NH 99-21R f AGENCY FOR HEALTH CARE (Leaed ADMINISTRATION, Respondent. FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on Anz A {AL , 2002, which i is incorporated by reference. The parties are directed to comply with the terms of the acchchea settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the [5 day of Agri | , 2002, in Tallahassee, Florida. , Rhonda M. Medows, 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 [Ts 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: Steven A. Grigas, Esquire Agency for Health Care Administration (Interoffice Mail) Peter Lewis, Esquire Goldsmith, Grout & Lewis, PA PO Box 1017 307 West Park Avenue Tallahassee, FL 32302-1017 Lisa Milton, Audit Services, Medicaid Program Analysis Julia Lee, Finance and Accounting ’ Willie Bivens, Finance ang, Account ing CERTIFICATE OF SERVICE I HEREBY CERTIFY Jthat a true and correct copy of. the foregoing has been furnished to the above named addressees by U.S. Mail on this the 2 day of , 2002: 7 Thee Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 N, Q oe STATE OF FLORIDA Mp DIVISON OF ADMINISTRATIVE HEARINGS, 49 * Q On bey 4 ARCADIA HEALTHCARE, LLC d/b/a Ke Shy 4 2. DOVE HEALTHCARE AT LAKE WALES, Wylpicnr 19 OM i, Petitioner, & vs. CASE NO: 01-0312 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT SRA MIEN TL AGREEMENT Petitioner, Arcadia HealthCare, LLC d/b/a Dove HealthCare at Lake Wales, and Respondent, Agency for Health Care Administration (“Agency”), by and through the undersigned counsel and representatives hereby stipulate and agree as follows: 1. The Agency agrees to revise the Petitioner’s Medicaid audit report for fiscal year ended September 30, 1996, in accordance with the attached letter from Steven Diaczyk to DawnSegler, dated October 8, 2001; 2. The Agency agrees to adopt this agreement in a Final Order; Upon the execution of this Agreement by all Parties, the Petitioner shall file te with the Agency a dismissal with prejudice of its Petition in this case; 4. Each party agrees to bear their own costs and fees associated with this matter. Notwithstanding the provisions of paragraph 4, nothing contained herein shall affect the reporting or allowability of the aforementioned costs or fees for subsequent reporting years, The Parties stipulate and agree that this Settlement Agreement is a legal and binding document yy enforceable in any Court of competent Jurisdiction. FhePartié. e-that t-the-event-that-any-action is brought-to_ ~enforee-the-provisions-oF this-Agreement-the-prevaiting party imthetaction-— ~inchading-any-appellate-action, shall be ontitled to the recouery ofits _———_ The signatories hereto represent and warrant that they are vested with the authority to execute this Settlement Agreement on behalf of their respective {" principals, and as duly designated representatives, to fully bind such principals. The Parties recognize and acknowledge that this agreement does not affect the tights and/or obligations of any party other than the Parties to this agreement, This agreement is binding on the parties’ Successors and assigns. 7H 5 Dated this the_/4 day pd 2001. ARCADIA HEALTHCARE, LLC d/b/a AGENCY FOR HEALTH CARE DOVE HEALTHCARE AT LAKE ADMINISTRATION WALES . KE Cire PETER A. LEWIS GOLDSMITH, GROUT & LEWIS, P.A. P.O. Box 1017 Agency for Health Care 307 West Park Avenue, Suite 200 Administration Tallahassee, Florida 32302-1017 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 WILLIAM ROBERTS, Esquire Acting General Counsel Agency for Health Care Administration H 2727 Mahan Drive, Building 3 : Tallahassee, Florida 32308 “poe BOB SHARPE Deputy Secretary for the Medicaid Program Agency for Health Care Administration . 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 STATE OF FLORIDA HCA AGENCY FOR HEALTH CARE ADMINISTRATION www.fdhe.state.flus * October 8, 2004 Ms. Dawn Segler Moore Stephens Lovelace, P.A, 307 West Park Avenue, Suite 202 Tallahassee, FL 32301-1422 Re: Dove Healthcare at Lake Wales Dear Dawn: Based on the documentation that you've provided to me, the audit adjustments would be changed as follows: We will change adjustment 6, account 631044, consulting service — medical records from (10,651) to (3,106). We will change adjustment 13, Other Patient care cost center from (17,621) to (1,312). We will change adjustment 13, account 631050, Dietary from (10,664) to (3,331). We will remove the (81,932) decrease to Capital replacements and the (1,263) decrease to Pass-through costs. If you have any questions, feel free to contact me at (727) 552-1155, Sincerely, Steven Biaczyk Audit Evaluation and Review Analyst MEDICAID AUDIT SERVICES $25 MIRROR LAKE DRIVE NORTH - SUITE 320C « sr. PETERSBURG, FLORIDA + 33701-3219 PAT PATTERSON: 727-552-1156 « SCS17-0931 + STEVE Dlaczyx: 727-582-1185 SC517.0930 FAX: 727-552-7093 | : pup STATE OF FLORIDA Poe DIVISION OF ADMINISTRATIVE HEARING AUG 16 PM &: 47 DEPARTMENT OF INSURANCE, A on Ne © it ue DIVISION OF WORKERS? HEARINGS VE COMPENSATION, Petitioner, vs. DOAH Case No. 02-3241 RANDY BELL'S CONSTRUCTION MANAGEMENT, INC., Respondent. / ey NOTICE OF REFERRAL This is a proceeding under the workers' compensation law by the Department of Insurance, Division of Workers' Compensation (Division) to enforce the statutory requirement that employers secure the payment of workers' compensation for their employees. The Division issued a First Amended Stop Work and Penalty Assessment Order against Randy Bell's Construction Management, Inc., (Bell), for its failure to abide by that requirement. Bell filed a Petition for Formal Administrative Hearing under section 120.57(1), Florida Statutes (2002). The Division refers the Petition and charging document (copies attached) to the Division of Administrative Hearings. § 120.569(2)(a), Fla. Stat. (2001). CERTIFICATE OF SERVICE Thereby certify that a copy of this Notice of Referral was served by U.S. Mail on Annemarie C. Craft, Esq., Stiles, Taylor & Grace, Post Office Box 1140, Tallahassee, FL 32302, attorney for Randy Bell's Construction Management, Inc., this 16th day of August 2002. Lind L Haar’ David C. Hawkins, Senior Attorney Fla. Bar No. 655279 Department of Insurance Division of Workers' Compensation-- Legal Office 200 East Gaines Street Tallahassee, FL 32399-4229 850-488-6498

Docket for Case No: 01-000312