STATE OF FLORIDA Woe Ag DIVISION OF ADMINISTRATIVE HEARINGS “ Lay BROOKSVILLE DRUGS, INC., d/b/a BROOKSVILLE DRUGS, Petitioner, Vv. . JUDGE: B.J Staros ~ oo, ° Ker dite De AK Ee > MDS AGENCY FOR HEALTH CARE ae 2 ADMINISTRATION, mt = Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a settlement agreement, which is attached and incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. aon DONE AND ORDERED on this the ao day of __4 Tent. , 2003, in Tallahassee, Florida. rept Rhonda M. Medows, MD, 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: William Furlow, Esquire Katz, Kutter, Alderman & Bryant 106 East College Avenue Tallahassee, Florida 32301 Anthony L. Conticello, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 UInteroffice) Tim Byrnes, Chief MPI Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, Florida 32308 (Interoffice) Robert Maryanski Medicaid Program Development Agency for Health Care Administration 2727 Mahan Drive, MS #20 (Interoffice) Willie Bivins Finance & Accounting Medicaid Accounts Receivables Agency for Health Care Administration 2727 Mahan Drive, MS #14 (Interoffice) B.J. Staros Administrative Law Judge DOAH Kathryn Holland Senior Pharmacist (Interoffice) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished - i to the above named addresses by U.S. Mail on this the © day of <| [stay , 2003. fo C Gy YorntZ ut C Maroy d »/ pe Lealand Mecha Ese oaire Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA wae , DIVISION OF ADMINISTRATIVE HEARINGS ay dy he ° AH o, BROOKSVILLE DRUGS, INC., d/b/a Agee 26 BROOKSVILLE DRUGS, Ge Petitioner, CASE NO: 01-1932 v. JUDGE: B.J Staros AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and BROOKSVILLE DRUGS, INC., d/b/a BROOKSVILLE DRUGS (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: 1. This Agreement is entered into between the parties for the purpose of avoiding the costs and burdens of litigation. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its Final Agency Audit Report dated April 16, 2001 (the "Audit Letter") AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $61, 801.32. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing that was assigned DOAH Case No. 01-1932, and requested the ability to submit additional documentation to mitigate this amount. The Agency reviewed this additional documentation which adjusted the overpayment to $6,063.23. PROVIDER agrees to pay the entire $6,063.23, as set forth in paragraph No. 4, below. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (a) (b) (c) (d) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of receipt of a fully executed copy of this Agreement, PROVIDER agrees to pay to AHCA the sum of SIX THOUSAND SIXTY THREE DOLLARS AND 23/100 ($6,063.23), to be made in one lump sum payment, as full and complete settlement of all claims. Payment shall due at AHCA 30 days after the entry of the Final Order. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as CI NO.: 00- 1819-000-3. PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Payment shall clearly indicate that it is per a settlement agreement, shal] reference the C.I. Number and the Medicaid Provider Number. 6. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shal] constitute PROVIDER’S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to PROVIDER for any Medicaid claims. 7. 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. 8. The parties agree to bear their own attorney’s fees and costs, if any. 9. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Settlement Agreement to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel the final hearing and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. 10. 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. 11.‘ This Agreement constitutes the entire agreement between PROVIDERS and the 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. 12. 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 Jaw, 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. 13. PROVIDER expressly waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of 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 herein. PROVIDER further agrees that the Agency should issue a Final Order which is consistent with the terms of _ this settlement, that adopts this agreement and closes this matter. 14, | PROVIDER, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses and expenses, of any and every nature "whatsoever, arising out of or in any way related to this matter CI NO.: 00-1819-000-3, and AHCA’s actions herein, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Facility. 15. 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. 16. 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. 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 18. All times stated herein are of the essence of this Agreement. 19. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. - BROOKSVILLE DRUGS, INC. d/b/a BROOKSVILLE DRUGS _ Ls Ju Dated: “arch 24th , 2003 By: Joe Rey Jr. (print name of above) Drag the »Pa, Its: nanan (print title above) (Affix Corporate Seal Above) ( Y DOs. Ld la Dated: Vorek 27) , 2003 WILLIAM FURLOW Attorney for Brooksville Drugs, Inc. AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Lobentlr.. Dated: fone A203 RUFUS NOBLE 7 Inspector General “P, ial 2 - ELA. LEP ~ Dated: Ziny AY , 2003 VALDA CLARK CHRISTIAN Zo General Counsel

Docket for Case No: 01-001932