STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION WINTER HAVEN HOSPITAL INC., Petitioner, vs. CASE NO. 01-2696 RENDITION NO AGENCY FOR HEALTH CARE ADMINISTRATION Respondent / FINAL ORDER THE PARTIES resolved all disputed issues and executed a “settlement agreement” reference. which is incorporated by 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 clean pest day of , 200%, in Tallahassee, Florida Rome Rhonda M. Medows, MD,!PAAFP, Secretary Agency for Health Care Administration AHCA- REDO OQ w - Pil ed 72S — MDP wo oe mvt =O 2 - 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: W. David Watkins, Esq. Watkins & Caleen, P.A. 1725 Mahan Drive, Suite 201 Tallahassee, Florida 32317-5828 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 W. F. Quattlebaum Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and Accounting Robert Maryanski, Medicaid Program Development 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 \ day of sebeua 200% a ee bein , Cioneene apse peices 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 WINTER HAVEN HOSPITAL, INC., Petitioner, vs. DOAH Case No. 01-2696 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, Winter Haven Hospital, Inc., 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 disputes that arose as the result of a KePRO review. 2. Ina final agency audit letter dated May 16, 2001, Petitioner was informed that the Agency did not believe that it was medically necessary to admit certain patients. Consequently, Respondent sought recoupment in the amount of $94,863.72. A copy of the recoupment letter is attached to this agreement. 3. In a petition dated June 5, 2001, Petitioner challenged Respondent’s action and requested a formal hearing. 4. After review of the case respondent agrees to withdraw the Final Agency Action Letter and not to seek recoupment for amounts indicated in the subject audit. 5. This settlement does not constitute an admission of wrongdoing or error by either party. However, the parties believe that this matter should be settled. 6. Both parties request that the Agency close the file in this case. 7. Each party shall bear its own attorney’s fees and costs. 8. 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 shal] be in Leon County, Florida. 9. Petitioner for itself and for its attorneys, heirs, executors or administrators, 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 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. Dated this day of of 2002. AGENCY FOR HEALTH CARE ADMINISTRATION Fa el Ved CL: Valda Clark Christian, General Counsel State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Building #3 Tallahassee, Florida 32308 Bob Sharpe, Deputy Secretary State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Building #3 Tallahassee, Florida 32308 ER HAVEN Vane d ne © Hospital Administrator Lance Anastasio Winter Haven Hospital 200 Avenue F, NE Winter Ha FL 8388 W. David Watkins & Caleen, P. A. 1725 Mahan Drive, Suite 201 Tallahassee, FL 32317-5828 Robert Maryanski, Medicaid Program Development Willie Bivens, Finance and Accounting

Docket for Case No: 01-002696