LUIS SANCHEZ CALDERON, MD, Petitioner, vs. DOAH CASE NO. 01-1968 Audit No. Rendition No. AHCA-01- 2.48-8- SO AGENCY FOR HEALTH CARE — ADMINISTRATION, ° phe Respondent. 2 / =o a = 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. DONE AND ORDERED on this the _2T ty of elim bor , 2001, in Tallahassee, Florida. Rhondaf¥I. Medows, MD, Secretary Agency for Health Care Administration vf f i ; t Qwest 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: Anthony C. Vitale Anthony C. Vitale, PA 799 Brickell Plaza, Suite 700 Miami, Florida 33131 Kelly A. Bennett Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 : Tallahassee, Florida 32308-5403 S.M. Lemer Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 NG Charlie Ginn, Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 ' Tallahassee, Florida 32308 Finance & Accounting eee epee CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail on this the Qe, day of lithe. 2001. a A. Lit £ GC Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5865 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS LUIS SANCHEZ CALDERON, MD Petitioner, DOAH CASE NO: 01-1968 v. - provider no.: 055232100 audit no.: C.I. 98-0208-000/WG2/JAD AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and LUIS SANCHEZ CALDERON, MD (“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 issued on April 13, 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 $90,844.10. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing that was assigned DOAH Case No. 01-1968. Subsequent to issuance of the Audit Letter, PROVIDER twice submitted additional documentation that AHCA reviewed and agreed that the overpayment was reduced to $89,454.94 and further reduced to $89,362.71. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: () G3) (4) (5) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. PROVIDER agrees to pay to AHCA, on or before October 19, 2001, the sum of seventy thousand dollars ($70,000.00) to be made in one lump sum payment, as full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 01- 1968). PROVIDER agrees that the payment is due on October 19, 2001. PROVIDER is responsible for ensuring timely delivery of the payment. Furthermore, failure to timely make the payment will render the full overpayment amount, $89,362.71, due and payable immediately, with interest, and interest will continue to accrue until the entire balance is paid. AHCA reserves the right to seek enforcement of this agreement by. any legal means. As a result of PROVIDER’S medical condition, effective immediately, PROVIDER withdraws from the Medicaid Program. PROVIDER agrees that he will discontinue participation in the program, and discontinue billing Medicaid-for services. PROVIDER agrees that should he wish to re-enroll in the Medicaid Program, prior to enrollment PROVIDER will participate in education courses regarding CPT coding and Medicaid billing. PROVIDER shall (6) 7) (8) () (10) attend and successfully complete a course primarily designed to teach CPT coding and Medicaid billing. PROVIDER agrees to provide written documentation of the successful. completion of the training AHCA, with an enrollment application, should PROVIDER seek to re-enroll. Nothing in this Agreement precludes PROVIDER from seeking re- enrollment in the Medicaid Program. However, nothing in this Agreement constitutes a guarantee that the application for enrollment will be accepted by AHCA. 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: C.I. 98- 0208-000/WG2/JAD PROVIDER agrees that despite his withdrawal from the Medicaid Program, any claims billed to Medicaid that are not resolved by this agreement, may be subject to further audits by AHCA. 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. PROVIDER agrees that failure to make payment per the terms of this agreement may result in the Agency pursuing all legal means to enforce 039) this agreement and may include a request for attorney fees and all costs associated with the enforcement of this agreement. Payment shall be made payable to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement, shall > reference the DOAH Case Number, and shall reference the C.I. Number. Payment should be directed to Kelly A. Bennett, Assistant General Counsel. 6. The parties agree upon receipt of payment from PROVIDER, AHCA will file a motion with the Division of Administrative Hearings that cancels the formal hearing in this matter. 7. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall 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. 8. 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. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. However, the parties believe that this matter should be settled because the parties have agreed to the terms contained within this agreement. 9. Each party shall bear its own attorneys’ fees and costs, if any. 10. 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 his signature alone binds him to make payments as set forth in this agreement. The parties further agree that a facsimile or photocopy reproduction of this agreement with PROVIDER’S signature shall be sufficient for the Agency to enforce the agreement and to cancel the hearing in this matter. 11. 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. 12. In the event that PROVIDER breaches this Agreement, and enforcement of this Agreement or recovery of damages for breach hereof is obtained by law or by legal proceedings through an attorney at law, all costs of collection or enforcement, including reasonable attorneys’ fees and costs, shall be paid by PROVIDER to AHCA. 13. This Agreement constitutes the entire agreement between PROVIDER 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. 14. 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 law, 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. 15. | 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. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 16. This Agreement is and shall be deemed jointly drafted and written by all patties to it and shall not be construed or interpreted against the party originating or preparing it. 17. 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. 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. eR rrp re ees Be BME Sao Thee rere LUIS SANCHEZ CALDERON, MD Dated: Lo ¢/O/ 2001 Dated: Ld| La v\ 2001 Counsel for Petitioner AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 . rn Dated: #f /2] , 2001 ufus PYoble Inspector General

Docket for Case No: 01-001968