STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION oad we HALIFAX MEDICAL CENTER, Petitioner, Sf tt clomel i” vs. CASE NO. 01-1148 . cas STATE OF FLORIDA, AGENCY Ls FOR HEALTH CARE ADMINISTRATION, , _ Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a “settlement agreement”, which is incorporated by reference. The parties are directed to comply with the terms of the “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the _ Lp day of “ Veneylnee , 2002, in Tallahassee, Florida. Rhonda M. Medows,\M.D., 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: David J, Davidson Halifax Community Health System Post Office Box 2830 Daytona Beach, Florida 32120-2830 Halifax Medical Center Hospital Administrator 303 N. Clyde Morris Blvd. Daytona Beach, Florida 32115-2830 Kim A. Kellum, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 S.F. Hood Administrative Law Judge Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and Accounting Mike Morton, Medicaid Program Integrity 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 ail or by Interoffice Mail on this the Cy day of a , 2002. \ Chav lene Max fs yRLealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION HALIFAX MEDICAL CENTER, Petitioner, vs. CASE NO.: 01-1148 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, Halifax Medical Center, by and through the undersigned individuals, hereby stipulate and agree as follows: 1. This settlement agreement is entered into between the parties in order to resolve a dispute that arose as the result of an Agency audit. 2. Ina final agency audit letter dated January 11, 2001, Petitioner was informed that the Agency determined that it was overpaid. Consequently, Respondent sought recoupment in the amount of $84,724.53. A copy of the recoupment letter is attached to this agreement. 3. In a petition dated January 24, 2001, Petitioner challenged Respondent’s action and requested an administrative hearing regarding the overpayment. 4. Subsequently, Respondent reviewed additional documentation presented to the Agency regarding the claims in question. After this subsequent review, Respondent recalculated the overpayment amount. 5. Accordingly, Respondent no longer contends that Petitioner owes Respondent $84,724.53. The recalculated overpayment amount is $59,474.36. 6. The Agency agrees to allow the Petitioner, Halifax Medical Center, to pay the Agency the total sum of $59,474.36 within sixty days (60) of receipt of the Final Order. 7. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 8. In the event the Petitioner fails to make any payment due hereunder, the Respondent may, at its option and upon fifteen days written notice to Petitioner, declare Petitioner in default. Its provider number shall be suspended until such time as the Agency receives payment of the balance in full. 9. This settlement does not constitute an admission of wrongdoing or error by either party. However, the parties believe that this matter should be settled. 10. Both parties request that the above-referenced file be closed. 11. Each party shall bear its own attorney’s fees and costs. 12. This agreement represents the entire agreement between the parties regarding settlement of this case. 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. The signatories to this agreement, acting in a representative capacity, represent that they are duly authorized to act on behalf of the parties to the agreement. Venue for any action arising from this agreement shall be in Leon County, Florida. Dated this day of of 2002. AGENCY FOR HEALTH CARE ADMINISTRATION o" “fp , oe Lhe lbp (LEE) alda Clark Christian General Counsel State of Florida Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Bob Sharpe Deputy Secretary of Medicaid State of Florida Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Post Off4ce Box 2830 Daytona Beach lorida 32120-2830 Halifax Medidal Center Hospital A nistrator 303 N. Clyde Morris Blvd. Daytona Beach, Florida 32115-2830

Docket for Case No: 01-001148