STATE OF FLORIDA linmae a DIVISION OF ADMINISTRATIVE HEARINGS meh 2 TALLAHASSEE MEMORIAL REGIONAL ered MER SLERK MEDICAL CENTER, Petitioner, z Dre sD Chad BE VS. CASE NO. 01-45034 JUDGE: D.W. DAVES: STATE OF FLORIDA, Ee AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER On June 28, 1999, Petitioner was notified that an FMQAI review resulted in an overpayment in the amount of $1,493.30. On October13, 2001, Petitioner requested a Formal Hearing. On December 13, 2001, the Petitioner filed a Notice of Voluntary Dismissal with the Division of Administrative Hearings. On December17, 2001, the Division of Administrative Hearings issued an Order Closing File. Based on the foregoing, Tallahassee Memorial Regional Medical Center is ordered to pay the amount of $1,493.30, the finding of the final agency audit report are adopted, and the file is CLOSED. DONE and ORDERED on this the Zz 3 day of Ty ; 2002, in Tallahassee, Florida. ph /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: Cynthia S Tunnicliff, Esquire Pennington, Moore, Wilkinson, Bell & Dunbar 215 S Monroe St, 2"! Floor Po Box 10095 Tallahassee, Fl 32302-2095 Anthony L. Conticello, Esquire Attomey for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Don W. Davis Administrative Law Judge Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Gloria Collins, Finance and Accounting Mike Morton, Medicaid Program Integrity CERTIFICATE OF SERVICE IT 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 241% day of , 2002. Cr Lidia, Ly How Lealand McCharen, Agency Clerk State of Florida, Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403

Docket for Case No: 01-004503