STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, A H Clore f vs. CASE NO. 01-2772 ENGAGEMENT NO. NHOO-103M LEESBURG REGIONAL MEDICAL CENTER, INC., Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement, 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 _! 4 day of Ma CL) _, 2003, Boe ay Rhonda M. Medows, MD, Secretary Agency for Health Care Administration in Tallahassee, Florida. 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: Garnett Chisenhall, Esquire Agency for Health Care Administration (Interoffice Mail) Peter A. Lewis, Esquire Goldsmith, Grout & Lewis, P.A. Post Office Box 1017 Tallahassee, Florida 32301-1017 (U.S. Mail) S. F. Hood Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Lisa Milton, Medicaid Program Analysis, MO & I 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 wi day of 4 M (inch , 2003. Charter She Lars BE Lealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTHCARE ADMINISTRATION, Petitioner, vs. DOAH CASE NO. 01-2772 ENGAGEMENT NO. NH00-103M LEESBURG REGIONAL MEDICAL CENTER, INC. Respondent. SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Respondent LEESBURG REGIONAL MEDICAL CENTER, INC. (“the PROVIDER”), by and through the undersigned, 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 The PROVIDER is a Medicaid provider in the State of Florida operating a facility that was audited by the Agency. 3, In audit engagement NH00-103M, AHCA audited the PROVIDER’S cost report for the audit period ending June 30, 1998. 4. In its Audit Report issued on June 5, 2001 pursuant to the foregoing audit engagement, AHCA notified the PROVIDER that a review of its cost report showed, in its opinion, some claims in whole or in part were not reimbursable by Medicaid. The Agency further notified the PROVIDER of the adjustments AHCA was making to the cost report. Ultimately, a petition for an administrative hearing was filed and assigned DOAH case number 01-2772. 5, The PROVIDER identified specific adjustments being contested. 6. Subsequent to issuance of the Audit Report, AHCA and the PROVIDER exchanged documents and discussed the disputed adjustments. 7. Ag a result of the foregoing discussions, the parties agree the Agency’s adjusiments which arc the subject of this proceeding, pertaining to the cost report of the PROVIDER for the audit year ending June 30, 1998 (audit engagement number NHO0- 103M), are valid except for the following: Adjustment number |, in the amount of $(20,435.00), will be removed. Adjustment number 5 will be revised from $(121,578.00) to $(98,476.00). Adjustment number 16, in the amount of $(74,885.00) will be removed. Adjustment number 25, in the amount of $(355,711.00) will be removed. Adjustment number 29, in the amount of $(243,818.00) will be removed. Adjustment number 32, in the amount of $(1,723.00) will be removed. Adjustment number 33, in the amount of $(6,612.00) will be removed. Furthermore, the Medical Supply charge reclassification of $130,786.00 from Medicaid to Medicare described on page three of the Audit Report will be removed. 8. In order to resolve this matter without further administrative proceedings, the PROVIDER and AHCA expressly agree the adjustment resolutions, as set forth above, completely resolve and settle this case. 9. The PROVIDER and AHCA further agree the Agency shall recalculate ie) the per diem rate for these time periods, and issue a notice of the recalculation. Where the PROVIDER was overpaid, the PROVIDER will remit payment to the Agency in the fall amount of the overpayment within thirty (30) days of such notice. Where the PROVIDER was underpaid, AHCA will remit payment to the PROVIDER in the full amount of the underpayment within forty-five (45) days of such notice. 10. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 Notice to the PROVIDER shall be made to: Leesburg Regional Medical Center C/o Kenny M. Ladd 4 600 East Dixie Avenue Leesburg, Florida 34748 Payment shall clearly indicate it is pursuant to a settlement agreement, shall reference the Case Number, and shall reference the audit/engagement number. ll. The PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute the PROVIDER’S authorization for the * . . . roe Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to the PROVIDER for any Medicaid claims. 12. AHCA is entitled to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable law. 13 This settlement does not constitute an admission of wrongdoing or error Les] by the parties with respect to this case or any other matter. However, the parties believe this matter should be settled because they have agreed to the foregoing terms. 14. Each party shall bear their respective attomeys’ fees and costs, if any. 15. The signatories to this Agreement, acting in their respective representative capacities, are duly authorized to enter into this Agreement on behalf of the party represented. The parties further agree a facsimile or photocopy reproduction of this Agreement shall be sufficient for the parties to enforce the Agreement. The PROVIDER agrees, however, to forward a copy of this Agreement to AHCA with original signatures, and understands a Final Order may not be issued until said original Agreement is received by AHCA. 16, 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. 17, This Agreement constitutes the entire agreement between the PROVIDER and AHCA, including anyone acting for, associated with, or employed by them, respectively, concerning all matters and supersedes any pnor discussions, agrecments, or understandings, there are no promises, representations, or agreements between the PROVIDER and 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. 18. This is an Agreement of settlement and compromise, recognizing 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. 19. The PROVIDER expressly waives in this matter its ight to any hearing pursuant to §§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, other than enforcement of this Agreement. The PROVIDER further agrees the Agency shall issue a Final Order which is consistent with the terms of this settlernent, that adopts this Agreement and closes this matter. 20. This Agreement is and shall be deemed jointly drafted and wnitten by all ‘parties to it and shall not be construed or interpreted against the party originating or preparing it. 21. To the extent 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. ‘ 25. This Agreement shall inure to the benefit of and be binding on each party’s successors, assi gus, heirs, administrators, representatives, and trustees. Leesburg Regional Medical Center CE Licawn Dated: (signature) By its, V7C oe PRESIOCOT _ (title) a 4 SITE CON WEG IL €0GC ¢ B) eH Dated: Da a f°", 2002 2 Fanail as Peter A. Lewis, Esquire Attorney for Respondent AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Bob Sharpe, Deputy Secretary, M&dicaid Dated: SY fe Lb 2 Valda Clark Christian, General Counsel C t Dated: izhi2/oz Gamett Chisenhall, Assistant General Counsel

Docket for Case No: 01-002772