ope STATE OF FLORIDA i? 2 DIVISION OF ADMINISTRATIVE HEARINGS % NORTH BROWARD HOSPITAL ', DISTRICT D/B/A BROWARD re GENERAL MEDICAL CENTER, ‘. Petitioner, ia G k- clos vs. CASE NO. 01-4510 . “PRerdehon WO AHGA- 03 AGA S-MbO STATE OF FLORIDA, AGENCY FOR HEALTH CARE 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 attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the vl day of Cuyiot . 2003, in Tallahassee, Florida. 2 pom Rhond Medgws, MD, Secretary Agency 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 I], Esquire Agency for Health Care Administration (Interoffice Mail) Venessa A. Reynolds, Esq. Conrad & Scherer, LLP North Broward Hospital District Post Office Box 14723 Fort Lauderdale, Florida 33302 (U.S. Mail) Florence Rivas Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Sue Gibson, Medicaid Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE | 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 || day of Gud (Of _, 2003. Crvisiuu Uhoupyd S€ 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 NORTH BROWARD HOSPITAL DISTRICT D/B/A BROWARD GENERAL MEDICAL CENTER, Petitioner, vs. CASE NO. 01-4510 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. SETTLEMENT AGREEMENT. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and North Broward Hospital District d/b/a Broward General Medical Center (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: L. This Agreement is entered into between the parties for the purpose of resolving the disputes between them and avoiding the costs and burdens of further litigation. Neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 010012901 and was a provider during the audit period. 3. In its final agency audit report (final agency action) dated October 3, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI), Office of the Inspector General, indicated that certain claims, in whole or in part, were not covered by Medicaid. The Agency sought recoupment of this overpayment, in the North Broward Hospital District d/b/a Broward General Medical 01-4510 Settlement Agreement amount of $184,380.91. In response to the audit letter dated October 3, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 01-4510. 4. Subsequent to the original audit that took place in this matter and in preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result, AHCA determined that the overpayment was adjusted to $122,207.66. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) (2) (3) (4) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of one hundred twenty two thousand two hundred seven dollars and sixty-six cents ($122,207.66) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 01-4510). AHCA retains the right to perform a 6-month follow-up review. PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.I. 01-0824- 000. PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. North Broward Hospital District d/b/a Broward General Medical 01-4510 Settlement Agreement 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 7. 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 terms of this agreement from any monies due and owing to PROVIDER for any Medicaid claims. 8. AHCA reserves 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 and regulations. 9. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 10. Each party shall bear its own attorneys’ fees and costs, if any. 11. 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. 12. 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. 13. 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. North Broward Hospital District d/b/a Broward General Medical 01-4510 Settlement Agreement 14, This is an Agreement of settlement and compromise, raade 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. 15. 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. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 16. 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. 17. 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. 18. | This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19. All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. North Broward Hospital District d/b/a Broward General Medical 01-4510 Settlement Agreement NORTH BROWARD HOSPITAL DISTRICT d/b/a BROWARD GENERAL MEDICAL CENTER f y fe f Ts FETS. fer Oe Dated: 2° 4 // © 2 , 2003 BY: (f/f (RE. (Print name) of Li best) C2 AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: Deguat ¥y , 2003 RufusNeble Judi th/e]. He Inspector General . Lo “ Yo ty; “ 2 " 0 Led fan Dated: y 40 _» 2003 Valda Clark Christian General Counsel 7 ra ZW M Dated: ly -2s _, 2003 L. Willian Porter IT Assistant General Counsel ER. ITS: _ OS 470 AHCA Fitep AGENCY FOR HEALTH CARE ADMINISTRATION G | N RHONDA NOL 20, fi}-8eQ Seonetany JEB BUSH, GOVERNOR October 3, 2001 CERTIFIED MAIL ~ 7001 0360 0003 1559 9579 ‘Provider No. 010012901 Ms. Linda DeBold Quality Regional Manager Broward General Medical Center 1608 S.E. 3rd Avenue Ft. Lauderdale, FL, 33316 RE: FINAL AGENCY AUDIT REPORT C.I. 01-0824-000 Dear DeBold: Therefore, it has been determined th in part are not covered by Medicaid. Medicaid policy handboo meet these guidelines. ee Visit AHCA oatine at www.fdhe.state fl.us -_ 2727 Mahan Drive « Mail Stop # Tallahassee, FL 32308 aS Broward General Medical Center page 2 59G-4.150 (06/09/96) and Florida Medicaid Hospital Appendix J, under Notice of Adverse Determination, verse determination was to be made in wniting to the PRO within sixty calendar days after receipt of the denial notice. Of the attached (see attachment) 70 claim(s) reviewed, according to our records your hospital did not submit a timely request for reconsideration by Florida Medical Quality Assurance, Inc. (FMQAD) on 67 claim(s). Therefore, you waived your rights to an administrative hearing. If you have additional documentation supporting a timely request for Teconsideration, please submit within 21 days or submit payment for these claims. Because of FMQAI’s termination of their Medicaid contract with AHCA, adverse determinations that were dated for June thru September 1999 will be granted hearing rights. For the remaining 3 claim(s), you have the ri ght to request a formal or informal hearing pursuant to section 120.569, RS. If a request for formal hearing is made, the petition must be made in compliance with rule section 28-106.201, Florida Administrative Code (RA.C.). If a request for an informal hearing is made, the petition must be made in compliance with rule section 28-106.301, EA.C. -Please note that rule section 28-106.201 (formal hearing) and 28-106.301 (informal hearing), EA.C., specify that the petition shall contain a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the petition must be received within twenty-one (21) days of receipt of this letter, and failure to timely request a hearing shall be deemed a waiver of your right to a hearing. Pursuant to Florida Administrative Code Coverage and Limitations, January 1999, request for reconsideration of an initial ad 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 Medicaid Program Integrity Office of 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 twenty-one (21) days 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 twenty-one (21) day period. , of the overpayment, send your check for $184,380.91. The check Agency for Health Care Administration, not to any employee t credit, be certain your provider number is shown on-your check, If you concur with the amount must be payable to the Florida of the agency. To ensure prope Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable P.O. Box 13749 Tallahassee, Florida 32317-3749 Broward General Medical Center page 3 Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts receivable, (850) 487-4298. Any questions you may have about this matter should be directed to: Sue Gibson, Research Assistant, Agency for Health Care Administration, Medicaid Program Integrity, 2727 Mahtin Drive, MS #6, Tallahassee, Florida 32308, telephone (850) 488-8194. Sincerely, Ando Mike Morton Program Administrator MVM:sbg Enclosures cc: Medicaid Program Development Area Medicaid Office Willie Bivens Medicaid Accounts Receivables PILED BROWARD GENERAL MEDICAL CENTER 0] Noy 20 PM 3:05 FMQAI DENIALS ° PROVIDER NUMBER 010012901 DIVISION OF ADMINISTRATIVE - eats — RECIPIENT . FIRST DISCHARGE DENIAL DENIALEND DENIAL OVERPAYMEN NO LAST NAME name AOMIT DATE DATE BEGINDATE DATE DAYS T "RECONSIDERATION DETERMINATION ~— 7624720060 Alsenat Simone 42/201997 12/21/1997 12/20/1997 12/21/1997 1 810.46 866957022 Benjamin Johnnie 4261998 04/28/1998 04/27/1908 04/28/1998 1 810.44 1425835104 Leath Shurrande 5/14/1998 05/15/1998 os/14/1998 08/15/1998 1 810,41 ADVERSE DETERMINATION {June thru September 1999) 7629599692 Aime Loveline 5/11/1998 08/20/1998 O5/14/1998 ov20/1908 6 4,862.46 £265932108 Belizaire Chelda 3/3/1998 OB/09/1998 Ow0E/1998 oB/0G/19¢8 3 2,431.23 3431443109 Belizaire Jessica 4/21/1998 05/01/1998 04/30/1998 —ov01/1998 1 810.41 7413821869 Bellavoix Aristide 12231997 12/25/1997 12/23/1997 12/25/1907 2 1,620.82 7722450962 Bockholtz Moesha Ve21998 01/24/1999 01/22/1999 01/24/1999 2 1,643.34 7507047997 Brinson Bobby 14/13/1998 14/26/1998 11/24/1998 11/25/1998 1 821.67 8132695089 Broderick Jr. Robert 12/21/1998 12/28/1998 12/25/1998 12/29/1998 4 " 3,286.68 1472538021 Brown Alicia 4/24/1998 04/28/1998 04/24/1998 04/28/1998 4 3,241.64 7451908437 Byrd Bryan 127997 12/20/1997 42/19/1997 42/20/1997 1 810.41 8135667370 Byrd Geneva 4111998 04/14/1998 04/19/1998 04/14/1998 1 810.41 1857861101 Clements Joyce 10/18/1998 10/22/1998 10/20/1998 10/22/1998 2 1,643.34 7627205034 Dassas Marie 6/23/1997 07/06/1997 06/28/1997 07/02/1997 5 3,989.25 8137140964 Davis James 8/20/1998 05/28/1998 08/26/1997 05/28/1997 2 1,620.82 7706762475 DeCel Juan 5/8/1998 06/11/1998 06/10/1998 06/11/1998 1 810.47 2997360110 Deshomme Jerry 5/12/1998 O8/19/1998 05/17/1998 08/19/1908 2 1,620.82 8145185696 DeVito Thomas 42999 04/15/1999 04/14/1999 04/15/1999 1 821.67 1565286103 Bush-EWiiot Yashica 9/14/1998 09/16/1998 09/14/1998 O9/16/1998 1 821.67" 2054965120 Ellis Andrew 10/28/1998 10/31/1998 10/28/1998 40/31/1998 3 2,465.01 7519315789 Epps —Benjamin 161998 11/11/1998 11/09/1998 11/11/1998 2 1,643.34 7519315789 Epps Benjamin 12/4/1998 12/07/1998 12/06/1998 1207/1998 1 821.67 76450778189 Foreman ‘Karena 5/3/1998 05/05/1998 05/03/1998 05/05/1998 2 1,820.82 7476632346 Gede Telamence 3/21/1998 03/25/1998 02/21/1998 02/25/1998 4 3,241.64 7334325737 Grissett Linda 8/26/1987 09/05/1997 09/03/1997 09/05/1997 2 1,620.82 7714881631 Hollman Shaneka 7/5998 07/08/1998 07/05/1998 07/05/1998 1 821.67 1425871127 Jolly Kevin 2/4/1999 02/08/1999 02/04/1999 O2/0B/1999 4 3,286.68 3249467022 Joseph Marie 10/8/1997 10/17/1997 10/08/1997 10/13/1997 6 . 4,569.32 7709105858 Phitlips-Kennt Angelica 5/11/1998 05/14/1998 05/13/1998 05/14/1998 . 1 810.41 8127076015 Kennedy Robert 3/17/1998 05/07/1998 o4/14/1998 08/07/1998 23 18,639.43 7586051160 Nys-Knutson Vaughn 427/998 oa/2e/1988 04/27/1998 04/29/1908 2 1,620.82 7516286893 Kolody Alisa 8/15/1998 08/22/1998 08/15/1998 08/22/1998 7 5,751.69 111564107 Landers Jenniter S7I1998 05/17/1988 05/17/1998 05/17/1998 1 810.41 7616850189 LeValley Richard 6/9/1998 OB/10/189B 06/09/1998 06/10/1998 1 810.41 7616850189 LeValley Richard 8/25/1998 09/04/1998 08/25/1998 09/01/1998 7 5,751.69 1862647135 Lortils Fiorence 1v90/1997 12/11/1997 12/10/1997 12/11/1997 1 810.41 7696254758 Martinez Jaime ¥111999 01/14/1999 01/14/1999 o1/14/1999 1 821.67 7809144361 McKenzie Olivia 7/31/1998 08/02/1998 07/31/1998 08/02/1998 2 1,643.34 7725618171 McNeil Josephine 1941998 11/08/1998 11/07/1998 1 oB/1998 1 821.67 7595624096 Mills Charles 10271997 10/29/1997 10/27/1997 10/29/1997 2 1,620.82 7340983601 Moore Christopher 1/23/1999 01/27/1999 01/26/1999 01/27/1999 1 821.67 81357778:7 Neuman David 12/2/1988 12/31/1998 12/10/1998 12/31/1998 21 17,255.07 7509021057 Ochy Wihetta 1181997 11/29/1997 11/27/9997 44/29/1997 2 1,656.44 7647632530 Odiesse Michetaire 5/27/1998 08/12/1998 06/08/1998 06/12/1998 4 3,241.64 3688339029 8145143047 7583416752 8113189904 2643943264 7728060848 8143529134 7518876639 2265591025 187539111 7863559248 7479822791 7526939091 7452499832 8195783736 7561089830 7486540762 8137218894 7673389681 7708811752 8146807241 7737700340 7618318085 8108684498 1514414317 Parrish Perez Pierre Protier Rahyns Rameau Raydenback Richardson Rivers Robest Scott Smails Smith Thomas Torres Thomas Thompson Tumer Velez Walker Walker Whipple Whitehead Williams Wilson Mary Hugo Daniei Robin Macon Maria John Fannie Tangela Lorraine Kamille Evelyn Roger Kathy Carmen Latrice Marion Jessie Fiosario Brittney Kemitha Arland Terret Charlie Jon 10/23/1998 2/23/1999 1/2/1998 27211999 12/16/7998 6/1999 12/10/1998 9/24/1998 12/20/1998 V6/1998 5/22/1998 5/21/1998 42/7/1998 6/16/1998 4/4998 2/3/1998 19/5/1998 14/10/1998 8/8/1998 324998 11/4/1998 V5/1999 6/2/1998 4/5/1998 10/1/1998 10/30/1998 02/27/1999 01/06/1998 02/05/1999 12/23/1998 01/06/1999 12/18/1998 09/01/1998 12/23/1998 01/10/1998 08/25/1998 08/26/1998 12/10/1998 06/18/1998 05/14/1998 02/05/1998 11/20/1998 11/17/1998 08/14/1998 03/28/1998 11/06/1998 01/06/1999 06/10/1998 04/14/1998 10/06/1998 10/26/1998 02/24/1999 01/02/1998 02/04/1999 12/46/1998 01/06/1999 ” 12/6/1998 08/30/1998 12/20/1998 01/09/1998 05/22/1998 05/25/1998 12/09/1998 06/16/1998 04/19/1998 02/04/1998 11/17/1998 11/16/1998 08/08/1998 03/24/1998 11/08/1998 01/05/1999 06/09/1998 04/10/1999 10/08/1998 10/30/1998 02/27/1999 01/08/1998 02/05/1999 12/23/1998 01/06/1999 12/18/1998 09/01/1998 12/23/1998 01/10/1998 05/25/1998 05/26/1998 12/10/1998 06/18/1998 05/14/1998 02/08/1958 11/20/1998 11/17/1993 08/14/199;3 03/28/1996, 11/06/1996 01/06/1999 06/09/1998 04/14/1999 10/06/1998 3,286.68 2,465.01 3,241.64 821.67. 5,751.69 821.67 821.67 1,643.34 2,465.01 810.44 2,431.23 810.41 821.67 1,620.82 20,260.25 810.41 2,465.01 821.67 4,930.02 3,241.64 821.67 Pw mee

Docket for Case No: 01-004510MPI