Gogh Tg STATE OF FLORIDA! i. E D AGENCY FOR HEATH CARR ADEN SANTO 0] a ee CAPE CORAL HOSPITAL, Petitioner, Cey\- CLO> vs. CASE NO. 01-4506 Provider #011971700 CI # 01-1022-000 AGENCY FOR HEALTH CARE RENDITION NO. + AHCA-02- 0098 -S-MDP ADMINISTRATION, 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 “settlement agreement”. Based on the foregoing, this proceeding is CLOSED. DONE and ORDERED on this the Via day of , 2002, in Tallahassee, Florida. fe Rhond . Medows, M.D., 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: Robert C. McCurdy System Vice President for Legal Services Lee Memorial Health System P.O. Box 2218 Fort Myers, Florida 33902 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 c.$. Holifield Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Willie Bivens, Finance and Accounting Mike Morton, Medicaid Program Integrity CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnish to the above naled addressees by U.S. Mail on this the {S day of 2002. gee Daire, Esquire Vir Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 STATE OF FLORIOA Attachment [ ~AHCA's 4, ICED AGENGY FOR HEALTH CARE ADMINISTRATION CA Ye APR {6 AM 9: 28 JEB BUSH, GOVERNOR RHONDA‘ Ne, Mi bow WS. A FAAFP, SECRETARY OXPART HT LET iScos ADMINIS RATIVE HE ARI INTEROFFICE MEMORANDUM RECEY Ve D RECt COUNSEL DATE: Octob 22, 2001 t eroner OCT 23 2001 TO: Bill Roberts Agency for Health SS al Counsel Care Administration FROM: Charles “623i: Medicaid Progra SUBJECT: Provider CAPE CORAL HOSPITAL I.D. # 011971700 Case # 011022000 ADMINISTRATIVE HEARING On this day, we have granted this Medicaid provider's request for: An informal administrative hearing, and we request your assignment of it to an Informal Hearing Officer. XXX__A formal administrative hearing, and we request your forwarding it to the Division of Administra- tive Hearings for their assignment of it to a ~ Formal Hearing Officer. The original of the provider's request and a copy of the Agency action letter are attached. Thank you for your cooperation. Attachments (2) Copy to: Willie Bivens, Medicaid Accounts Receivable, with attachments Med.Prog.Int.Adm. (08/06/01) Visit AHCA Online at 2727 Mahan Drive © Mail Stop #6 www fdhe state flus Tallahassee, FL 32308 FILED STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 92 APR 16 AM 9:97 OVI Sox oe CAPE CORAL HOSPITAL, aerate TIVE - } S . Petitioner, vs. CASE NO.: 01-4506 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, Cape Coral Hospital, 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 a dispute that arose as the result of an KePRO audit. 2. It a final agency audit letter dated September 27, 2001, Petitioner was informed that the Agency determined that it was overpaid. Consequently, Respondent sought recoupment in the amount of $10,475.43. A copy of the recoupment letter is attached to this agreement. 3. Ina letter dated October 16, 2001, Petitioner challenged Respondent’s action and requested a formal hearing regarding the overpayment. 4. Subsequently, Respondent reviewed additional documentation presented to the Agency regarding the claims in question. After this subsequent review, Respondent recalculated the overpayment amount. 5. Accordingly, Respondent no longer contends that Petitioner owes Respondent $10,475.43. The recalculated overpayment amount is $6,601.43. 6, The Agency agrees to allow the Petitioner, Cape Coral Hospital, to pay the Agency the total sum of $6,601.43 within thirty days (60) of execution of the Settlement Agreement. 7. Payment shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 8. In the event the Petitioner fails to make any payment due hereunder, the Respondent may, at its option and upon fifteen days written notice to Petitioner, declare Petitioner in default. Its provider number shall be suspended until such time as the Agency receives payment of the balance in full. 9. This settlement does not constitute an admission of wrongdoing or error by either party. However, the parties believe that this matter should be settled. 10. Both parties request that the above-referenced file be closed. ll. Each party shall bear its own attorney’s fees and costs. 12. 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 shall be in Leon County, Florida. 13. 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 Lyf day of arch of 2002. AGENCY FOR HEALTH CARE ADMINISTRATION La William H. Roberts Acting General Counsel State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Center #1 Tallahassee, Florida 32308 ufugy Noble, Inspector Generali State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Center #1 Tallahassee, Florida 32308 CAPE CORAL HOSPITAL - Robert C. McCurdy am Legal Services Department Lee Memorial Health System P.O. Box 2218 Fort Myers, Florida 33902-2218 Gx 777. Jruct bd Cape Coral Hospital Post Office Box 2218 Fort Myers, Florida 33902-2218 Cc: Mike Morton, Medicaid Program Integrity

Docket for Case No: 01-004506MPI