7 i i j 3 STATE OF FLORIDA me DIVISION OF ADMINISTRATIVE HEARINGS PARK SHORE PHARMACY, / ~ Petitioner, Y Ly chine ‘ { ed ae o vs. CASE NO. 01-2780 ‘ STATE OF FLORIDA, Ts AGENCY FOR HEALTH CARE a ADMINISTRATION, j Respondent. / FINAL ORDER THIS CAUSE is before me for issuance of a Final Order. On May 25, 2001 the Agency issued its Final Agency Audit Letter, constituting final agency action in this case, demanding $59,546.47 in recoupment of Medicaid overpayments. In due course, Park Shore Pharmacy (“Petitioner”) petitioned for a formal hearing. On July 26, 2001 the Petitioner withdrew its petition for a formal hearing and on August 27, 2001 the Division of Administrative Hearings issued an Order Closing File and remanded the case to the Agency. Based on the foregoing, the request for a hearing is dismissed. It is ORDERED and ADJUDGED that Petitioner refund forthwith, the sum of $59 546.47, together with statutory interest as is set forth in §409.913(24)(b), Florida Statutes. DONE and ORDERED on porter. bsv21 2002, in Tallahassee, Florida. ed Rhond . Medows, MD, Secretary 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: L. William Porter II Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) William M. Furlow, Esquire Katz, Kutter, Haigler, Alderman, Bryant & Yon, P.A. 106 E. College Avenue, Suite 1200 Tallahassee, Florida 32302-1877 (U.S. Mail) Patricia Malono Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Judy Hefren, Deputy Inspector General Kelly Rubin, Medicaid Program Integrity Willie Bivens, Finance & Accounting CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above-named addressees by U.S. Mail WETeN Joee (4, 2002. Chis 4>@ 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 on STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS PARK SHORE PHARMACY, Petitioner, v. DOAH CASE NO. 01.2780 Judge: Patricia H. Malono Audit No. CI 00.0972.001.3 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / NOTICE OF WITHDRAWAL OF PETITON FOR FORMAL PROCEEDINGS COMES NOW the Petitioner, by and through the undersigned attorney, and withdraws its Petition for Formal Proceedings, and requests that this matter be remanded to the Respondent, Agency for Health Care Administration, for further proceedings. CERTIFICATE OF SERVICE I] HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by United States Mail to L. William Porter, Assistant Genera] Counsel, 2727 Mahan Drive, Building #3, Suite 3431 Tallahassee, Florida 32308 on this 26" day of July, 2001. Respectfully submitted, < William M. Furlow Katz, Kutter, Haigler, Alderman, Bryant & Yon, P.A. 106 East College Avenue Tallahassee, Florida 32301 850.425.1679 WMF'jb HAUSERS\BILLA\GiHis\Withdrawal.072501 doc yO02. ak ok {oa OC SO parr ae ~Y sari, we cacy manage : we TIVE ‘ag, FEE WOT VAP 33138 VL bam Pah Ae r SUDIT REPORT No. <0 -O97 3°901-3/KDR yyaen & aPpran St zany IMEZ ry has CO pleted 118 review of your pal jedicaid jaims with gates of {ror 3. party |: 997 through Decemd og. WE nave review your paid claims gre SS )* “Epo gen no Procrit (awa Epoeun alf “Erythropore in, EPO) pexFermum and a= n Dp uran) a Ccalcije% ( Calcitnio!) fo dually gidl Medicare/Mece™ ms eaicaid is the payor of last ri for these arugs £9 dicaid panents treated for age pa aisease OFS renal failure who are als eligible for Meaicat® benefits Since care page f° iwaney faut) may require up to 4 3 month Wallin pen A for qnitiaion: nai Cone vy caiculaions ot include paid Me ycaid claims for the Tee pient that fell in th Bey ays of trearmen Fou are hereby noufied that re nave dere g that Park re PT cartes aco ave 546.47 fOr claims tat 1m whole oF 10 part are vered BY sca oS re otal amount ave 1 §59.546-4 The ab acu) and your sont of appeal are 23se= peor dere ari PHO paymen pursuant ° Medicaid policy: the Mesicaid program rilizes applicable ovis BO = of Caper 0) jorda Sratutes. ), Chapter 3 \orida ‘a.grnimistraunve Code xc.) med card prove’! apooks. State en medicaid P icy. and ederal laws and egul aiot > as 2 g. Med caid cannot erly pay for clams at do NOt mee’ Medicaid equ™ Te ens. jow 18 4 giscussion of the P icul 5 pol yes elated t ou eview of your cairn > 4 an janaion ¢ why thes© cial a Medic) a equiremen's Th ™m ycaid PT der AST erent states that the Pro agrees 10 participalé yn the Florida Me aic? on naer the terms and ondit ifie' ihe provider g eement. This jn} wd xis not yited tO complyine with fe laws an egula ons. state Jaws ana rules ar wies caid jrandbooks anda policies cece 409.933 (Aya), SHES: noverpayment snchudes 20Y unt that wh diob ma} y the medicaid program whether paid 2s @ result of inaccurate OF cost repomes mp pe claimins- ynacceptavle practices: fraud. abus stake yas AHCA online at wey fdive crate Ji HS Park Shore Pnarmuacy @ © Pave 2 Secuon 409.910. F.S.. specifies that Medicaid be the pavor of last resort for medically necessary goods and services furnished to Medicaid recipients. Secuion 409.913(7). F.S.. states that a provider is responsible for the preparation and submission of a claim thatis true and accurate and is for the goods und services that are provided in ccordance with applicable provisions of all Medicaid rules, regulations. handbooks. policies, federal, state, and local jaws, Section 409.913(10). F.S., states in pan that the Agency may require repayment for mappropnate, medically unnecessary, or excessive goods or services. Section 409.913(14), F.S., states in part that: “The agency my seek any remedy provided by law, including, but not limited to, the remedies provided in subsections (12) and (15) and s. 812.035, if:” “(e) The provider is not in compliance with provisions of Medicaid provider publications that have been adopted by reference as rules in the Flonda Administrative Code; with provisions of state or federal laws, rules, or regulations: with provisions of the provider agreement between the agency and the provider: or with certifications found on claim forms or on transmittal forms for electronically submitted claims that are submitted by the provider or authorized representative, as such provisions apply to the Medicaid program;” REVIEW DETERMINATIONS The “Prescribed Drug Services Coverage and Limitations Handbook”, February 1996, page 2-9; and November 1997, page 9-10; states that, “The Medicaid prescribed drug services program does not reimburse for infusion therapy or other injectable drugs, including erythropoietin alpha and parenteral nutrition, that are administered by a dialysis facility for dually eligible Medicare/Medicaid beneficiaries. The facility or the supplier must bill Medicare for the services provided to the recipient”. The “Medicare Intermediary Manual. Part 3”. (HCFA-pub. 13-3). states in-part, that Medicare pays for medically necessary equipment, supplies and services for the treatment of patients with chronic renal failure whether it 1s provided in a renal dialysis facility or self administered in the horne. We have reviewed claims data that indicates you have received payment for claims for Medicaid recipients who are being treated for end stage renal disease or chronic renal failure and are Medicare eligible. Linder these terms and conditions, Medicare pays for these prescribed drugs. Since we are the payor of last resort. we have identified these claims as an overpayment. The overpayment identified on the jasi page of the claims attachment is with regard only to Epoetin alfa, tron Dextran and Calcitnol billed for dually eligible Medicare/Medicaid recipients and comprenends only the audit period. January 1, 1997, through December 31, 1998. The attached printout identifies all relevant claims involved in the overpayment. Accordingls. as shown on the attachment. we have determined at this time that vou have been overpaid by the Medicaid program in the amount of $59.546.47. If additional overpayments are found subsecuently, vou will be notified. If vou accept or concur with these findings. please send vour check in the amount of $89.546.47. for the idenunied 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 vour 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. Ifa petition for formal hearing is made, the petition must be made in compliance with rule section 28-106.201. Florida Administrative Code (F.A.C.). Please note that rule section 28-106.201(2), F.A.C., specifies that the petition shal] contain a concise discussion of specific items in dispute. Additionally, vou 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 umely requesi a hearing shall be deemed a waiver of your right to a hearing. It is important that a request for an informal hearing or a petition for a formal hearing be sent only to the following address: Mr. Charles G. Ginn, Chief Mecicaid Program Integrity ffice of the Inspector General Agency for Health Care Administration 2727 Mahan Drive. Mail Stop #6 Tallahassee. Florida 32308-5403 Do not send requests or petitions to any other address. If a hearing request is not received within 21 davs 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 2)-day penod. Park Shore Pharmacy ®@ ® - Page 4 Any questions that you may have regarding this matter should be directed to: Kelly Rubin, 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/gwm Attachment ce: Medicaid Program Integrity Administrative Section Willie Bivens, Medicaid Accounts Receivable Medicaid Program Development Area Medicaid Office

Docket for Case No: 01-002780