STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CONSOLIDATED GROUP OF MADISON, INC., d/b/a MADISON NURSING CENTER, Petitioner, = - o vs. DOAH CASE NO. 01-4117 STR oo Audit No. NH 01-029M Cesc! . Rendition No. AHCA-0£-0065_ S--MDA AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputcd issues and executed a settlcment 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 |} dayof_(VWar@n __, 2008 in Tallahassee, Flot . crest Rhonda M. 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: Michael J. Bittman, Esquire Gray, Harris & Robinson, P.A. Post Office Box 3068 Orlando, FL 32802-3068 Kelly A. Bennett, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassec, Florida 32308-5403 (Interoffice Mail) Suzanne F. Hood Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Maggie Kendrick" mos Medicaid Program Analysis : Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #21 Tallahassee, Florida 32308 (Interoffice Mail) Finance & Accounting ba) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail on this the Z / day of 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5865 STATE OF FLORIDA F | L E B DIVISION OF ADMINISTRATIVE HEARINGS MAR 13 02 AHCA CONSOLIDATED GROUP OF MADISON, QEPARTMENT CLERK INC., d/b/a MADISON NURSING CENTER, Petitioner, v. DOAH Case No. 01-4117 = Judge Suzanne F. Hood -..:~ a3 Audit no. NH 01-029M ~ Provider no. 213462 Bau = AGENCY FOR HEALTH CARE eo ADMINISTRATION, ce Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “‘the Agency”), and MADISON NURSING CENTER (“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, operating a nursin: we, : home that was audited by the Agency. 3. The Agency conducted audits of the PROVIDER’s cost report for the period ending August 31, 1998. 4. In its Audit Report issued on August 14, 2001, AHCA notified PROVIDER that a review of the cost report revealed that, in its opinion, some claims in whole or in part were not reimbursable by Medicaid. The Agency further notified PROVIDER of the adjustments, which AHCA was making to the cost reports. In response to the audit report, PROVIDER filed a timely petition for an evidentiary hearing that was assigned DOAH Case No. 01-4117. In its petition for evidentiary hearing, PROVIDER identified specific adjustments that it appealed. Subsequent to issuance of the audit report, AHCA and PROVIDER exchanged documents and discussed adjustments that were at issue. As a result of the aforementioned exchanges, the parties agree that the Agency’s adjustments which were the subject of these proceedings, as they relate to the cost report for the period ending August 31, 1998, from the Madison Nursing Center (audit # NH01-29M), shall be resolved as follows: a. Adjustment #5. This adjustment has been reduced from ($635) to ($130). b. Adjustment #6. This adjustment has been removed. c. Adjustment #8. This adjustment has been removed. d. Adjustment #11. This adjustment has been reduced from ($2,896) to ($503). e. Adjustment #12. This adjustment has been removed. f. .® Adjustment #13. This adjustment has been removed. g. Adjustment #14. This adjustment has been reduced from ($1,403) to ($711). h. Adjustment #17. This adjustment has been reduced from ($4,800) to ($1,200). i. Adjustment #21. This adjustment has been removed. j. Adjustment #22. This adjustment has been removed. k. Adjustment #24. This adjustment has been changed from ($2,143) to $827. 1. Adjustment #28. The appeal of this adjustment has been withdrawn. m. Adjustment #35. This adjustment has been removed. Home office: n. Adjustment #1. The appeal of this adjustment has been withdrawn. 0. Adjustment #2. This adjustment has been reduced from ($1,052) to ($340). p. Adjustment #3. This adjustment has been reduced from ($2,239) to ($51). q. Adjustment #4. This adjustment has been reduced from ($227) to ($69). I. Adjustment #6. The appeal of this adjustment has been withdrawn. s. Adjustment #7. This adjustment has been removed. Adjustment #8. The-appeal of this adjustment has been withdrawn. c u. Adjustment #9. This adjustment has been reduced from ($344) to ($194). v. Adjustment #13. This adjustment has been reduced from ($9,216) to ($3,794). w. Adjustment #14. This adjustment has been reduced from ($6,235) to ($954). Xx. Adjustment #15. Changed comment to “To disallow costs directly ~ ,2allocable to chain components.” y. | AHCA will use the fixed mortgage interest rate of 13.738% to calculate the Medicaid property FRVS per diem rate. 8. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree that the adjustment resolution, as set forth above, will resolve and settle this case completely. 10. 11. 12. PROVIDER and AHCA further agree that the Agency shall recalculate the per diem rate for these time periods, and issue a notice of the recalculation. Where PROVIDER was overpaid, PROVIDER will remit payment to the Agency in the full amount of the overpayment within forty-five (45) days of such notice. Where 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. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 PROVIDER Consolidated Group of Madison, Inc., d/b/a Madison Nursing Center Route 3, Box 2310 Madison, FL 32340-9540 And payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the audit number. 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 2 terms of this agreement from any monies due and owing to PROVIDER for'any Medicaid claims. PROVIDER and AHCA reserve 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. 13. 14. 15. 17. 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. Each party shall bear its own attorneys’ fees and costs, if any. 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. The parties further agree that a facsimile or photocopy reproduction of this agreement shall be sufficient for the parties to enforce the agreement and to cancel the hearing in this matter. PROVIDER agrees, however, to forward a copy of this agreement to AHCA with original signatures, and understands that a Final Order may not be issued until said agreement is received by AHCA. 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. 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 executed by the parties. 19. 20. 21. 22. 24, 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. PROVIDER expressly waives in this matter 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, other than enforcement of this Agreement. PROVIDER further agrees that the Agency shall issue a Final Order which is consistent with the terms of this settlement, that adopts this Agreement and closes this matter. 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 originating or preparing it. 2. ot To the extent that 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. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. All times stated herein are of the essence of this Agreement. 25. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. CONSOLIDATED GROUP OF MADISON, INC., d/b/a MADISON NURSING CENTER, er, Director Petifioner/Provider rockal 9. (ithinen ichael J. Bittnan Florida Bar No. 0347132 Gray, Harris & Robinson, P.A. 301 E. Pine Street, Suite 1400 Post Office Box 3068 Orlando, FL 32802-3068 (407) 843-8880 Telephone (407) 244-5690 Facsimile AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Pew [Su Bob Sharpe ‘ Deputy Secretary, Medicaid Assistant General Counsel Dated: _/ aha , 2001 Dated: /R/ TH , 2001 Dated: 0 Dated: 127 13 2001

Docket for Case No: 01-004117