STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS WESTSIDE REGIONAL MEDICAL CENTER, Petitioner. 4 ? ri} CA -chnf _. CASE NO. 01-4511 Edt 1 Me. BIRGER OS-O! BD vs. 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 |\© day of —YACGI4_, 2003, in Tallahassee, Florida. Rhonda M. , 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, Esquire Agency for Health Care Administration (Interoffice Mail) Jeffrey T. Royer, Esquire Buckingham, Doolittle & Burroughs, LLP 2500 N. Military Trail, Suite 480 Boca Raton, Florida 33431 (U.S. Mail) Claude Arrington Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Bureau Chief, Medicaid Program Integrity Daniel Washburn, Medicaid Program Development Willie Bivens, Finance and 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 on this the _iOday of MACIN _, 2003. CG rteup Ohpucbscid O€ealand McCharen Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 eerie eG RSE 3 a ee tepmen nts WESTSIDE REGIONAL MEDICAL CENTER DOAH No. 01-4511 Provider No. 011230500 C.1. No. 01-1066-000 SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION ("AHCA” or “the Agency”), and Westside Regional Medical 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, and neither party concedes the other's position. 2. PROVIDER is a Medicaid provider in the State of Florida. 3. In its final agency audit report dated October 1, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity (MPI) indicated that, in its opinion, some claims in whole or in part were not covered by Medicaid. The Agency sought overpayment in the amount of $28,998.66. In response to the audit letter dated October 1, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 01-4511. 4. The PROVIDER submitted additional documentation which was reviewed and a determination was made that the alleged overpayment of $28,998.66 be reduced to $863.99. Westside Regional Medical Center Settlement Agreement 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) (2) (3) (4) (5) 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 pay the amount of eight hundred sixty-three dollars and ninety-nine cents ($863.99) (referred to herein as the “settlement amount) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 01-4511). PROVIDER and AHCA agree that full payment of the settlement amount will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.!. 01-1066-000. 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. In the event AHCA offsets, inadvertently or otherwise, all or a portion of the settlement amount from any future Medicaid reimbursement payable to PROVIDER (except as is permitted by paragraph 7), AHCA agrees that PROVIDER may credit the amount of any such offset against the settlement amount at the time PROVIDER remits payment. ronnie pC ntact. Westside Regional Medical Center Settlement Agreement 6. Payment shail 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. acerca eta ete ES ru Mery Westside Regional Medical Center Settlement Agreement 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. 14. 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 or law, which may form the basis, in whole or in part, of such party's motivation to settle as provided herein. Regardless of the existence of any potential incorrectness, mistake or error in any parties understandings, information and contentions as to facts or law, each of the parties hereto agree that no misunderstanding, misinformation, mistake or error of fact or law, shall be a ground for rescission of this agreement. 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 Westside Regional Medical Center Settlement Agreement 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 shail 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. WESTSIDE REGIONAL MEDICAL CENTER VE Dated: Hey 1S , 2002 BY! _ OSCAR Vice area (Print name) ITS: Westside Regional Medical Center Settlement Agreement FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mait Stop #3 Tallahassee, FL 32308-5403 Dated: a , 2003 Bob Sharpe Deputy Secretary, Medicaid ? / Z / LF Khelil Mee (1 ? Dated: 1% x, / , 2003 Valdd&C. Christian General Counsel yV\ Dated: O2- G , 2003 L. Willia er JI Assistant General Counsel

Docket for Case No: 01-004511MPI