STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION}HEAI}# LAKE PARK OF MADISON, Petitioner, vs. CASE NO.: - 01-0334 = =p Rendition no. AHCRED&- eeu ~SiMDA STATE OF FLORIDA, AGENCY Se er FOR HEALTH CARE . ADMINISTRATION, } SEN -Claseol Respondent. FINAL ORDER This cause came before me for the purpose of issuing a final agency order, it appearing | from the Settlement Agreement, attached and incorporated herein, that there are no remaining disputed is issues of fact. Co ms . ___ EINDINGS OFFACT a Ce ; 1 On lug G 200 | , a Settlement Agreement between the parties was executed which dismissed the Petitioners case against the Agency. 2. There are no remaining disputed issues of fact or law. _ CONCLUSIONS OF LAW The Agency has jurisdiction over the parties and subject matter pursuant to Section 120.57, Fla. Stat. (2000). The parties are directed to comply with the terms of the Stipulation, Settlement and Dismissal. The petition is dismissed and the file is closed this eh. day of wi lea F- ~, 2001. SRD pe (ane Laura Branker Acting 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, 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 OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. Copies Furnished to: S.F. Hood Mary Stewart, CPA Administrative Law Judge Manager, Audit Services DOAH AHCA, Bldg. #3 1230 Apalachee Parkway 2727 Mahan Drive Tallahassee, FL 32399-3060 Tallahassee, FL 32308 Steven Grigas, Esquire AHCA, Bldg. #3 2727 Mahan Drive ‘Tallahassee, FL 32308" SOS Tallaha Pam Williams = Reimbursement Manager _ City Center 100 Vine Street Murfreesboro, TN 371300 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS LAKE PARK OF MADISON, Petitioner, DOAH CASENO. 01-0334 vs. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ) SETTLEMENT AGREEMENT - Respondent, Agency for Health Care Administration (“Agency”) and Petitioner, Lake Park ofMadison (“LAke Park”), hereby stipulate in full and complete settlement of the above-styled case, that: 1. The Agency shall revise its audits of Lake Park’s Medicaid cost report for the fiscal year ending February 29, 1996 as follows: A. The report shall be revised in accordance with the letter to Ms, Pam Williams from Ms. Lisa Milton, dated June 5, 2001. B. The above noted letter is herein attached and incorporated as Exhibit “A” to this agreement. 2. Based upon this Agreement and the revisions set forth, the Petitioner agrees to dismiss its petition in this case with prejudice. i 3. The AHCA agrees to adopt and incorporate this Agreement in its Final Order. 4. Each party agrees to bear their own attorney’s fees and costs associated with this action. 5. Nothing contained herein shall bar the reporting or affect the allowability of the costs and fees referenced in paragraph 4 above for future reporting periods. AGREED TO this 0” “Way o , 2001. FOR THE AGENCY: FOR LAKE PARK: tea Co Lbianw VEN A. GRIGA: PAM WILLIAMS Fla. Bar No. 0981818 Reimbursement Manager Agency for Health Care Administration National Health Care 2727 Mahan Drive, Bldg. #3 100 Vine Street Tallahassee, Florida 32308-5403 Murfreesboro, TN 37130 (850) 922-5873 (615) 890-2020- BOB SHARPE Deputy Director of Medicaid Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3 Tallahassee, Florida 32308-5403 General Counsel Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3 Tallahassee, Florida 32308-5403 (850) 922-5873 CERTIFICATE OF SERVICE LERTIFICATE OF SERVICE THEREBY CERTIPY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the 9 day of 2001. R.S. Power, Esquire Agency Clerk State of Florida

Docket for Case No: 01-000334