STATE OF FLORIDA ; DIVISION OF ADMINISTRATIVE HEARINGS oe no wht THOMAS E. MATHIAS, D.O. ; ao Ce and Petitioner, ee CASE NO: 02-0024mprz ve CI NO: 99-0005-000 PROVIDER NO:0650170-00 AGENCY FOR HEALTH CARE RENDITION NO.: AHCA-02~172 -S-mMpO ADMINISTRATION, Respondent. / eee FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement 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_Z5 day of unt , 2002, in Tallahassee, Florida. hb V— (7 Rhonda M. Medows, MD, FAAFP, Secretary Agency for Health Care Administration 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: Anthony L. Conticello, Esquire Agency for Health Care Administration (Interoffice Mail) Gary J. Clark, Esquire Sternstein Rainer & Clarke 101 N. Gadsden St. Tallahassee FL. 32301 Charlie Ginn, Chief, Medicaid Program Integrity Willie Bivens, Finance and Accounting CERTIFICATE OF SERVICE SL EE OP SERVICE THEREBY CERTIFY that a true and correct copy of the foregoing has been yes furnished to the above named addresses by U.S. Mail on this the a) thay of Ceohth\ Ws Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5865 , 2002. STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS THOMAS E. MATHIAS, D.O., Petitioner, CASE NO: 02-0024MPI vy. JUDGE: F.L. BUCKINE AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT PRN AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), Thomas E. Mathias, D.O., (“PROVIDER”), by and through the undersigned, hereby stipulate and agree as follows: I. 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. 3. In its Final Agency Audit Reports issued on October 24, 2001 (the "Audit Letter") 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 $49,768.81. In response to the Audit Letter, PROVIDER filed a petition for a formal administrative hearing disputing AHCA’s findings and this matter was assigned DOAH Case No. 02-0024MPI. Subsequent to issuance of the Audit Letter, PROVIDER submitted additional documentation to AHCA, and met with AHCA’s peer physician. Upon review of the additional documentation, and upon adjustment of findings by AHCA’s peer physician, AHCA determined that the Overpayment was $19, 482.31 (the “Overpayment”), PROVIDER agreed to pay the entire Overpayment and agreed to pay AHCA an additional $5 000.00 in investigative fees and costs. 4. In order to resolve this matter without further administrative proceedings, PROVIDER and AHCA expressly agree as follows: (a) AHCA agrees to accept the payment set forth herein in settlement of the Overpayment issues arising from the MPI review. (b) PROVIDER agrees to pay to AHCA the amount of $24,482.37 (the “Settlement Amount”) as full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 02-0024MPI). The Settlement Amount is broken down as follows: $19,482.37 Overpayment and $5,000.00 Investigative Fees and Costs = $24,482.37 Settlement Amount. PROVIDER shall pay the Settlement Amount in 24 equal monthly payments, bearing interest at 10 percent per year. An amortization schedule is attached and incorporated here only for teference as to the amount of each monthly payment, The first payment shall be due thirty (30) days after full execution of this Settlement Agreement and entry of a Final Order. (c) PROVIDER is responsible for ensuring timely delivery of the payment. Furthermore, failure to timely make the payment will render the balance due and payable immediately, with interest, and interest will continue to accrue until the entire balance is paid. AHCA reserves the ri ght to seek enforcement of this agreement by any legal means. (d) PROVIDER and AHCA agree that full payment as set forth above will resolve and settle this case completely and release all parties from all liabilities arising from the findings in the audit referenced as: C.I. No. 99- 0005-000. (e) PROVIDER agrees that it will not rebil] the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 5. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 And payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the C.I. Number. 6. PROVIDERS 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. 7. 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. 8. The parties agree to bear their own attorney’s fees and costs, if any. 9. The signatories to this Agreement, acting in a Tepresentative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. Furthermore, PROVIDER agrees that its signature alone binds PROVIDER to make the payment as set forth in this agreement. PROVIDER shall furnish the actual signed Settlement Agreement to AHCA, however a facsimile copy shall be sufficient to enable AHCA to cancel the final hearing and have the Division of Administrative Hearings relinquish jurisdiction back to the Agency. 10. 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. 11. 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. 12. 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. 13. PROVIDER expressly waives in this matter its ri ght 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 tules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that the Agency should issue a Final Order which is consistent with the terms of this settlement, that adopts this agreement and closes this matter. 14. Provider, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys 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 DOAH Case No 02-0024MPI, C.I. No. 99-0005-000, 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. 15. 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. 16. 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. 17. 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. Lvntt 4 O2-COLY MPT FROM : LAW OFFICE PHONE © 813 6511437 ‘ i Hee ELS teres agency eit OMe NO é 13 85114 Apr. 18 2082 12:31PM ppg Ti CARE An 820 415 9513 P.98-10 PETITIONER: , £ \ Dbthe Dated: YAS 2002, BY: Thomes Matias, DO. rs, President gd 19159 ON “O'0 S¥IKLYN SYNOH! NEL 2002 “Qe dae AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mai! Stop #3 Tallahassee, FL 32308-5403 afer dsr Dated: fe i , 2002. RUFU: OBLE Inspector General LA be lo Dated: Ce (4 , 2002. WILLIAM ROBERTS Acting General Counsel

Docket for Case No: 02-000024MPI