STATE OF FLORIDA SEP |! AGENCY FOR HEALTH CARE ADMINISTRATION ve JOSE I. DOMINGO, MD, ‘ Yawn CMD & Petitioner, vs. , DOAH CASE NO. 01-2578 (previously 01-1156) Audit No. CI-94-0982-307-2 “, Rendition No. AHCA-01-220_-S-49? & ¢ < con we AGENCY FOR HEALTH CARE , ADMINISTRATION, 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. DONE AND ORDERED on this the _/ hh day of Leagns [ , 2001, in Tallahassee, Florida. Rhonda fie Secretary ia 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: Jeffrey C. Fulford, Esquire 1240 U.S. Highway One North Palm Beach, FL 33408 Kelly A. Bennett, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Robert E. Meale Administrative Law Judge Division of Administrative Hearings The DeSoto Building . 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Charlie Ginn, Chief Medicaid Program Integrity Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 | Tallahassee, Florida 32308 Finance & Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy ‘of the foregoing Final Order has been furnished to the above-named persons or entities, by U.S. Mail or inter-office mail, on this: 14. day of Saplimbor_, 2001. Diane A. Grubbs, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 ; Fort Knox Building III, MS 3 Tallahassee, Florida 32308 850/922-5865 STATE OF FLORIDA ; DIVISION OF ADMINISTRATIVE HEARINGS JOSE I. DOMINGO, MD, Petitioner, CASE NO: 01-2578 (previously 01-1156) vs. JUDGE: ROBERT E. MEALE AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and JOSE I. DOMINGO, 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 January 18, 2001 (the "Audit Letter") AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPJ) 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 $9,507.91. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing that was assigned DOAH Case No. 01-11156. Subsequent to issuance of the Audit Letter, AHCA re-reviewed the documents submitted by the PROVIDER and the parties met informally to discuss and resolve ; all outstanding issues. AHCA found that, in its opinion, the amount of overpayment was a $9,312.91. PROVIDER specifically denies that there was any overbilling and that there is an overpayment, but chooses to resolve this matter for other reasons. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: ) (1) ~AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (2) PROVIDER agrees to pay to AHCA, on or before August 15, 2001, the sum of seven thousand, two-hundred fifty dollars ($7,250.00) to be made in one jump sum payment as full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 01-1156, and later DOAH Case No. 01-2578). (3) | PROVIDER is responsible for ensuring timely delivery of the payment. Furthermore, failure to timely make the payment will render the balance 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. (4) 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. 94-0982-307-2. (5) PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subj ect of the audit in this case. fe oes a (7) PROVIDER agrees that failure to make payment per the terms of this agreement may result in the Agency pursuing all legal means to enforce this agreement and may include a request for attorney fees and all costs associated with the enforcement of this agreement. 5. Payment shall be made 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. 6. 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. 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. 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 patties. Furthermore, PROVIDER agrees that his signature alone binds him to make the payment as set SRE Te Ser oR Se TR TT RE k i i : 7 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 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 and costs, shall be paid by the breaching party to the non-breaching party. 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 ex executed bya the Parties. : ae 14. ° This i is an Agreement of settlement and compromise, made in recognition that the | parties may have differe t ori correct und st dings i formation and contentions, as to facts and law, and: with each party compromising and settling any potential correctness or vee Suelo thy on setlist ane Slnecrepenore Riadaher NR Arraeennadnea dura ind tac hidatieta vaaied enna tonnes aise al ied aoe cia cote diet dey an incorrectness ss of its understandings, information and contentions as to facts and law, so that no | . rE 7 + £ = misunderstandin or misinformation shall bea, ound for re ission hei of. g pursuant to sections 120. 569 ¢ or 120. 37, Florida Statues, the making of findings o of fact and conclusions of law by the Agency, and all farther and other proceeding to which it may be entitled by law or oper eren wre eet perpen oon yar rat: i i z008) miles 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 thig settlement, that adopts this agreement and closes this matter. 16. 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 otiginating or preparing it. 17. To the extent that any provision of this Agreement is prohibited by Jaw for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shail 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. Alltimes stated herein are of the esseace of this Agreement. 20. ‘This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. JOSE J. DOMINGO, M.D. AGENCY FOR HEALTH CARE : OR ~ ADMINISTRATION . “2727 Mahan Drive, Mail Stop #3 : Tallahassee, FL 32308-5403 gold _ 7 OT Wa bret $ oat Ya PICT AML to/Pe/L0 pelle Rufus Noble, Inspector General Xe’ /Assistant General Counsel ae a Dated: A, 2001 agree ee

Docket for Case No: 01-002578