STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS CGH HOSPITAL, LTD. d/b/a CORAL GABLES HOSPITAL, Petitioner, p Ly vs. CASE NO. 02-0711 C.I. NO. 01-1049-00 STATE OF FLORIDA, RENDITION NO.: AHCA~O2- -S-MDP AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on October 9 , 2002, 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 __9__ day of __October , 2002, in Tallahassee, Florida. Rhonda M. Medows, , Secretary Agency for Health Care Administration ASS SS SSSR eshte seme 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 DOME ative Law Judge - e DeSoto Building Agency for Health Care 1230 Apalachee Parkway Administration Tallahassee, FL 32399-3060 (Interoffice Mail) Michael J. Glazer, Esquire Ausley & McMullen Post Office Box 391 Tallahassee, Florida 32302 (U.S. Mail) Judy Hefren, Acting Bureau Chief, Medicaid Program Integrity Debbie Lynn, Medicaid Program Integrity Kathleen Cook, Medicaid Program Development Willie Bivens, 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: i ‘day oof of ( TOUCL , 2002. (! hae kee TR bi Gu 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 CGH HOSPITAL, LTD. d/b/a CORAL GABLES HOSPITAL, Petitioner, Vs. CASE NO. 02-0711 C.I. NO. 01-1049-00 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA” or “the Agency”), and Coral Gables Hospital (“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 December 4, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Analysis (MPA) 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 $68,325.31. In response to the audit letter dated December 4, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 02-0711MPI. 4. The PROVIDER submitted additional documentation, which was reviewed and the overpayment was adjusted to $51,232.78. Corai Gables Hospital Settlement Agreement Cl 01-1049-00 5. In order to resolve this matter. without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) | AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPA review. (2) Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment in the amount of thirty thousand seven hundred thirty nine dollars and sixty-seven cents ($30,739.67) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 02-0711MPI). As a sanction, MPI will do a re-audit in 6 months. (3) | 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.|. 01-1049-00. (4) 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. 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Coral Gables Hospital Settlement Agreement Cl 01-1049-00 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. Coral Gables Hospital Settlement Agreement Cl 01-1049-00 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 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 shalt 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. a a Coral Gables Hospital Settlement Agreement Cl 01-1049-00 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. CGH HOSPITAL, LTDF. d/b/a CORAL GABLES HOSPITAL Vrs Lerten Dated: Lepolonkee Me , 2002 BY: MARTHA CARCI 2 (Print name) ITs: CEO AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: Li O7 2 , 2002 Bob Sharpe Deputy Secretary for Medicaid Lyf Af. Kvaldl Gai i Dated: fol rs , 2002 Valda Clark Christian General Counsel Ewetlted dtu bates: _ [0-4 “202 L. William Porter II Assistant General Counsel rn a eae sensi enssen- STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION “4 be RHONDA M, MEDOWS, 4D, FASFP SECRETARY =~ SPT EER Vie ge “Sy JEB BUSH, GOVERNOR CERTIFIED MAIL ~ RETURN RECEIPT REQUESTED er #7000 0600 0026 4137 5939 ye Date: December 4, 2001 Provider No. 010960600 Coral Gables Hospital! Hospital Administrator 3100 Douglas Road Coral Gables, FL 33134 RE: FINAL AGENCY AUDIT REPORT C.I. 01-1049-00 Dear Administrator: This review and the determination of overpayment were made in accordance with the provisions of Florida Statutes Section 409.913. In determining payment pursuant to Medicaid policy, the Medicaid Program utilizes procedure codes, descriptions, policies, Medicaid Bulletins, Statements of Policy and the limitations and exclusions found in the Medicaid provider handbooks. In applying for Medicaid reimbursement, providers are required to follow the guidelines set forth in the applicable rules and Medicaid fee schedules, as promulgated in the Medicaid policy handbooks and billing bulletins. Medicaid cannot pay for services that do not meet these guidelines. Since this determination is final action by the Agency for Health Care Administration, you have the right is made, the request or petition must Additionally, you are hereby informed that if a request for a hearing ure to timely request a hearing shall be received within twenty-one (21) days of receipt of this letter. Fail be deemed a waiver of your right to a hearing. —_- Visit AHCA Online at 2727 Mahan Drive » Mail Stop # www fdhe. state flus Tallahassee, FL 32308 a rc Tc us isu anSnGs SSSSnnesiah tie SURE Coral Gables Hospital Page 2 It is important that a request for an informal hearing or petition for formal hearing be sent only to the following address: Mr. Charles Ginn, Chief Medicaid Program Integrity Office of the Inspector General Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #6 Tallahassee, FL 32308-5403 Do not send the request or petition to any other address. Ifa 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. : [fF you concur with our findings, remit by check in the amount of $68,325.31. The check must be payable to the Florida Agency for Health Care Administration, not to any employee of the Agency. To ensure Proper credit, be certain your provider number is shown on your check. Please mail to: Agency for Health Care Administration Medicaid Accounts Receivable P.O. Box 13749 Tallahassee, Florida 32317-3749 Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts receivable, (850) 921-4396, Any questions you may have about this matter should be directed to: Hank Landis, Systems Project Analyst, Agency for Health Care Administration, Program Development, 2727 Mahan Drive, Building 3, Room 2354, Tallahassee, Florida 32308, telephone (850) 921-8273, Sincerely, Ihde Mike Morton, Program Administrator KB/mm Enclosure ce: Area Medicaid Office Medicaid Accounts Receivable Vistt AHCA Online at www. fdke. state. fl.us 2727 Mahan Drive « Mail Stop # Tallahassee, FL 32308

Docket for Case No: 02-000712MPI