STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS FEMY DRUG CORPORATION d/b/a BO CEL. FARMACIA OLYMPIA, BEE Petitioner, % vs. CASE NO. 01-2150 PROVIDER NO. 10456610 STATE OF FLORIDA AUDIT NO. C. I. 01-0099-000-3 R e -01-238-S- AGENCY FOR HEALTH CARE ENDITION NO.: AHCA-01-238-S-MDP ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on _ August 27 __, 2001, which is 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 £7 Khiay whl 50% in Taliahassee, Florida. Whe f Rhond - Medows, MD, Secretary \ Agency for Health Care Administration fle aie Lc eet eee 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: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) _ Errol Powell The Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-30060 Harvey W. Gurland, Esquire Duane, Morris & Heckscher LLP 200 S. Biscayne Boulevard, Suite 3410 Miami, Florida 33131 Charlie Ginn, Chief, Medicaid Program Integrity JoAnn Jackson, Medicaid Program Integrity Willie Bivens, Finance and Accounting 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. Mail on this the Uy — IN, f ot ylalltr, 2001. Y, Lo) Diane Grubbs, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 oR. Bir fas bree paipergise cme ime mene wn Seer meme me oe tere ER (MPI) indicated that, in its opinion, some Claims i in whole, orin part, were not covered by Jc aneb meus f FEMY DRUG CORPORATION dib/a FARMACIA OLYMPIA DOAH No. 01-2150 Provider No. 104566100 C.I. No. 01-0099-000-3 _ SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION ("AHCA” or “the Agency’), and Femy Drug Corporation d/b/a Farmacia Olympia . (‘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, and neither party concedes the other's position. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its final agency audit report dated April 11, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity on AS RRR SAHA LSE Poco PO RRS a Medicaid. The Agency sought overpayment in the amount of $50, 786. 93. [In response to the audit letter | dated April 1 2001, PROVIDER fi d assigned D H Case administrative hea expressly agree as $follows: _ 7 coe sb ssrelenbaminindaege aie ARB coi (1) AHCA agrees to accept the Payment set forth he _ of the leged overpayment issues arising from the MPI review and asian de agrees not toi impose any other r administrative. or ci il p but not limited to, suspension tate oF we RE (3) (4) “= any manner for claims that were not covere “from all liabilities arising from the findings in 1 the audit referenced as from the Medicaid program or the imposition of an administrative _ fine. | Within thirty days of receipt of the final order. in this matter, PROVIDER agrees to make the first installment of twenty-six (26) consecutive weekly installment payments, which includes at statutory interest of 10%, of one thousand nine hundred thirty-four dollars and sixty-four cents ($1,934.64) to repay the agreed upon sum of forty nine thousand seventeen dollars and eighty-six cents ($49,017.86). The weekly payments of $1,934.64 shall be deducted from the weekly Medicaid checks made payable to PROVIDER by the AHCA’s Finance and Accounting Department in full and complete settlement of all claims in the proceedings before the ? Division of Administrative Hearings (DOAH Case No. 01-2150). PROVIDER and AHCA agree that full payment as ‘set forth above a will resolve and settle this case completely and release both partes i are the ranean of the audit i in this case. State of Florida, the Rules of the Medicaid Program, and all other applicable rules and . regulations. 6. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matier. However, the parties believe that this matter should be settled because the parties have agreed to the terms contained within this agreement. 7. Each party shall bear its own attorneys’ fees and costs, if any. 8. 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. 9. 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. oe 10. In the event that a party 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, shall be paid by the @ breaching party to the ‘non-breaching party. 11. This is Agreement constitutes the entire agreement between PROVIDER aere ve and ‘the ‘AHCA, inclu ing anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandi ; there are no promises, representations or agreements between PROVIDER and the AHCA other than as set forth herein, No modification 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 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. 13. PROVIDER expressly waives in this maiter 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 it shall not challenge or contest any Final Order entered in this ‘matter which is consistent with the fers of this settlement agreement i in any forum now or in the future available to it, inclucing the right - to any administrative proceeding, circuit or federal court action or any appeal. i 14, ; _ This Agreement i is and shall be deemed fointly drafted and written by all : ~ fess aston eli ene eee aaa | : “ paitios to it an shall not t be > construed or interpreted against the party originating or ; SRR RB A SR RR IRM na oes, ee Lae H SE YR | Biss este x . © preparing it. 15. “To the extent that any provision of this Agreement is prohibited by law FOr RRS RR 16. This Agreement shall inure to the benefit of and be Binding o on each Party's s successors, assigns, heirs, administrators, representatives and trustees. 17. _ All times stated herein are of the essence of this Agreement. 18. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. , 2001 (Print name) s:_ Veasident_ FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 a Abe Dated: of /2 , 2001 Rufus Ndble Inspector General : a Dated: Sey /y , 2001 Julie Gallagher ® General Counsel L. Willian Porter Assistant General Counsel i : STATE OF FLORIDA ' HCA AGENCY FOR HEALTH CARE AOMINISTRATION JEB BUSH, GOVERNOR RUBEN J. KING-SHAW, JR, SECRETARY April 11, 2001 CERTIFIED MAIL - RETURN RECEIPT NO. 7099 3400 0013 8444 9751 Provider No. 1045661 00 License No. PH0006702 Juan Aulet, Owner ¥ ry Femy Drug Corporation : : R E Cc E | V E D d/b/a Farmacia Olympia 9884 Bird Road MAY 02 2001 Miami, Florida 33165 . A MEDICAID PROGRAM RE: FINAL AGENCY AUDIT REPORT INTEGRITY C.I. No. 01-0099-000-3/H/gDg Dear Mr. Aulet: 2000. The Florida Medicaid Program through the Agency for . overpaid $50,786.93 in connection with claims submitted to . Medicaid during the audit period(s) specified, This conclusion is supported by the audit results. . This review and the determinations were made in accordance with the provisions of Chapter 409, Florida Statutes (F.S.), and Chapter 59G, Florida Administrative Code (F.A.C.). In applying for Medicaid reimbursement, providers are required to follow the _.applicable statutes, rules, Medicaid provider handbooks, “ statements of Medicaid policy, and federal laws and regulations. Medicaid cannot Properly pay for claims that do not meet Medicaid requirements. When a provider receives payment in violation of these provisi # a : The audit included a judgmental samp Ea analysis of a random sampling during the audit period. The audit period for this review was from January 4, 1999, through July 21, 2000. This review identified a non-extrapolated $1,167.80. i a ae: Fe - t i a ‘ fig Fi ; 2727 Mahan Drive « Mail Stop #6 Sees Visit ANCA Online at Fa <. Tallahassee, FL 32308 . anne ia ew fdhe.state fl.us ps 2 Lo : e e : . cs . i 7 ; Exhibit A - HEE ae “Juan Aulet, Owned ; i Page 2 The audit also included a comparison of your lawful documented product acquisitions with your paid Medicaid claims. The audit period for this review was from January 4, 1999, through July 21, 2000. The drug quantity billed to Medicaid, in many instances, exceeded the quantity available to dispense to Medicaid recipients. This review identified an overpayment of $49,619.13. Attached are the overpayment calculations. We combined the non-extrapolated overpayment findings with the acquisition shortage overpayment. Accordingly, we have determined at: this time that you have been overpaid by the Medicaid program in the amount of $50,786.93. If you accept or concur with these findings, please send your check in the amount of $50,786.93 for the identified overpayment, made payable to the Florida Agency for Health Care Administration, to: Agency for Health Care Administration Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 (Note: The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the agency.) To ensure proper credit, be sure that your provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens at (850) 487~4298. ; You have the right to request a formal or informal hearing pursuant to section 120.569, F.S. If a petition for formal. - hearing is made, the petition must be made in compliance with rule section 28-106.201, F.A.C. Please note that rule section 28-106.201(2), F.A.c., specifies that the petition shall contain »@ concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within “twenty-one (21) days of receipt of this letter. Failure to “timely request a hearing shall be deemed a waiver of your right to a hearing. mportant that a request for an informal hearing or a A petition for a formal hearing be sent only to the following . : address: . . Cee seth heute Basis ese ; Mr. Charles G. Ginn, Chief t is Medicaid Program Integrity R E “FTWPrry /Office of the Inspector General C E IV E D Agency for Health Care Administration. : 2727 Mahan Drive, Mail Stop # 6 MAY 0 2 200! Tallahassee, Florida 32308-5403 poe RP BoE Tepe we RES EE . CAHeritage Audits\FarmaciaOlympiaAAL Juan Aulet, Owne Page 3 Do not send requests or petitions to any other address. If a hearing request is not received within 21 days from the date of receipt of this letter, the right to such hearing is waived, and repayment of the above-stipulated overpayment will be due and payable at the end of that 21-day period. Any questions that you may have regarding this matter should be directed to: JoAnn D. Jackson, Senior Pharmacist, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive, Mail Stop # 6, Tallahassee, Florida 32308-5403, telephone number (850) 922- 4374. Sincerely, D. Kenneth Yon Program Administrator Medicaid Program Integrity DKY/Jjdj Attachments cc: Medicaid Program Integrity Administrative Section Medicaid Accounts Receivable, Attn: Willie Bivens Heritage Information Systems, Inc. Medicaid Program Development, Pharmacy Services Area Medicaid Office RE ~- MAY 0 2 2001 MEDICAID PROGRAM INTEGRITY CEIVED _ ee TORRE CPR eR MEER ET OE TR tee ee eae pene we ee ieccnRe Me ee rma eee

Docket for Case No: 01-002150