Petitioner: SOUTH BEACH MATERNITY ASSOCIATES
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION
Judges: PATRICIA M. HART
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Apr. 18, 2002
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, November 21, 2002.
Latest Update: Dec. 24, 2024
FILEB
STATE OF FLORIDA
DEC -3 02
DIVISION OF ADMINISTRATIVE HEARINGS CA
DEPARTMENT C
SOUTH BEACH MATERNITY CLERK
ASSOCIATES,
Petitioner, Pu booed
vs. CASE NO. 02-1594 OU
STATE OF FLORIDA, ae
AGENCY FOR HEALTH CARE po
ADMINISTRATION, *
Respondent. a =
/ :
FINAL ORDER
THE PARTIES resolved all disputed issues and executed a Settlement
Agreement on ov !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 / ” day of eversbe’ , 2002,
in Tallahassee, Florida.
Rhonda M. Medows, 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 I], Esquire
Agency for Health Care
Administration
(Interoffice Mail)
Alan J. Huber, Vice President
Miami Beach Maternity Center
1259 Normandy Drive
Miami Beach, Florida 33141
(U.S. Mail)
Patricia Malono
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Judy Hefren, Deputy Inspector General
Sharon Dewey, Medicaid Program Integrity
Willie Bivens, Finance and Accounting
CERTIFICATE OF SERVICE
I 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 SF day
RY Lealand Glavine Wipf pse
Agency Clerk
State of Florida
Agency for Health Care Administration
2727 Mahan Drive, Building #3
Tallahassee, Florida 32308-5403
(850) 922-5873
of , 2002.
STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
SOUTH BEACH MATERNITY
ASSOCIATES,
Petitioner,
vs. CASE NO. 02-1594
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Respondent.
/
SETTLEMENT AGREEMENT
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
(‘AHCA” or “the Agency”), and South Beach Maternity Associates
(“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 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 690012700.
3. In its final agency audit report (final agency action) dated February
14, 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 amount of $9,000.00.
In response to the audit letter dated February 14, 2001, PROVIDER filed a
petition for a formal administrative hearing, which was assigned DOAH Case
No. 02-1594.
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 $8,000.00.
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 MPI
review.
(2) Within thirty days of receipt of the final order, PROVIDER
agrees to make a lump sum payment of eight thousand
dollars ($8,000.00) in full and complete settlement of all
claims in the proceedings before the Division of
Administrative Hearings (DOAH Case No. 02-1594). 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.I. 01-0462-046.
(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
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.
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 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.
SOUTH BEACH MATERNITY ASSOCIATES
Le... Dated: O cf 2 Ly 22002
ft J WIG ese
(Print name)
ITS: _Vlcx« fb ESE AT
AGENCY FOR HEALTH CARE
ADMINISTRATION
2727 Mahan Drive, Mail Stop #3
Tallahassee, FL 32308-5403
Lafrdb pated: /7// , 2002
Rufugy Noble
Inspector General
Avia ME pated: _@-_ /Y , 2002
Valda Clark Christian
General Counsel
*‘ “Aw
lyn ie Dated: I(- Z "__, 2002
L. William Porter II
Assistant General Counsel
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
JEB BUSH, GOVERNOR RUBEN J. KING-SHAW, JR., SECRETARY
Cp
February 14, 2001 ire
Wer
CERTIFIED MAIL-RETURN RECEIPT REQUESTED 7001 0360 0003 15606796
Provider No. 690012700
SOUTH BEACH MATERMITY ASSOCN.
DBA MIAMI BCH MATERNITY CTR
1259 NORMANDY DRIVE
MIAMI BEACH, FL 331410000 -
In Reply Refer to
FINAL AGENCY AUDIT REPORT
C.1. 01-0462-046/WG 2/SJD
Dear Provider:
The Medicaid Program Integrity office has completed a review of Medicaid claims for the
procedures specified below for dates of service during the period July 1, 1996 through
January 31, 2001. Based on this review, we have made a determination that you were overpaid
$9,000.00 for claims that in whole or in part are not covered by Medicaid.
This review and the determinations of overpayment were made in accordance with the provisions
of Section 409.913, Florida Statutes. In determining payment pursuant to Medicaid policy, the
Medicaid program utilizes procedure codes, descriptions, policies 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.
Below is a discussion of the particular guidelines related to our review of your claims and an
explanation of why these claims do not meet Medicaid requirements. An attached computer
printout lists the claims that are affected by this determination.
Visit AHCA Online at
2727 Mahan Drive » Mail Stop #6
www. fdhe.statefl.us
Tallahassee, FL 32308
Final Agency Audit Report Letter
Page 2
“Medicaid reimburses licensed midwives and birth centers for procedure code X5907
labor management for recipients who labor at home or at the birth center and are then
transferred to the hospital for delivery.”
1. You billed and received payment for procedure code X5907 labor management
services when the recipient delivered at home and or at a birth center without
being transferred to the hospital. This amount is considered an overpayment.
If you concur with the amount of the overpayment, send your check for $9,000.00. 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
Post Office Box 13749
Tallahassee, Florida 32317-3749
Questions regarding payment should be directed to Ms. Willie Bivens, Medicaid accounts
-ecelvable, (850) 921-4396.
You have the right to request a formal or informal hearing pursuant to section 120. 569, FS. Ifa
yetition for formal hearing is made, the petition must be made in compliance with rule section
18-106.201, F.A.C. Please note that rule section 28-106. 201(2), F.A.C., specifies that the
Jetition shall contain a concise discussion of specific items in dispute. Additionally you are
\ereby informed that if a request for a hearing is made, the request or petition must be received
vithin twenty-one (21) days of receipt of this letter. .
t is important that a request for an informal bearing or a petition for a formal hearing | be
ent 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
Tallahassee, Florida 32308-5403
io not send requests or petitions to any other address. Ifa hearing request is not received within
venty-one (21) days from the.date of receipt of this letter, the right to such hearing is waived,
id repayment of the above stipulated overpayment will be due and payable at the end of that
venty-one (21) day period.
Final Agency Audit Report ‘ter
Page 3
If you have any questions about this matter, contact Sharon Dewey, Registered Nursing
Consultant, Agency for Health Care Administration, Medicaid Program Integrity, Office
of the Inspector General, 2727 Mahan Drive, Mail Stop 6, Tallahassee, Florida 32308-5403,
telephone (850) 410-0759,
Sincerely,
Williams
AHCA Administrator
SAW:SJD:em
Enclosures
_ ce: Medicaid Accounts Receivable
Medicaid Program Development
Medicaid Program Integrity Administration
Medicaid Program Integrity Work Group Five
Area Medicaid Office
Docket for Case No: 02-001594MPI
Issue Date |
Proceedings |
Dec. 03, 2002 |
Final Order filed.
|
Nov. 21, 2002 |
Order Closing File issued. CASE CLOSED.
|
Nov. 18, 2002 |
Joint Motion to Relinquish Jurisdiction (filed by Respondent via facsimile).
|
Nov. 14, 2002 |
Joint Motion to Hold Case in Abeyance (filed by Respondent via facsimile).
|
Oct. 02, 2002 |
Order Continuing Case in Abeyance issued (parties to advise status by November 8, 2002).
|
Sep. 18, 2002 |
Status Report and Agreed Motion for Abeyance (filed by Respondent via facsimile).
|
Aug. 05, 2002 |
Letter to Judge Malano from A. Huber requesting audit report be removed from website (filed via facsimile).
|
Aug. 01, 2002 |
Order Continuing Case in Abeyance issued (parties to advise status by September 6, 2002).
|
Jul. 30, 2002 |
Status Report and Agreed Motion for Abeyance (filed by Petitioner via facsimile).
|
May 30, 2002 |
Order Granting Continuance and Placing Case in Abeyance issued (parties to advise status by July 26, 2002).
|
May 28, 2002 |
Joint Motion to Hold Case in Abeyance (filed via facsimile).
|
May 13, 2002 |
Order of Pre-hearing Instructions issued.
|
May 13, 2002 |
Notice of Hearing issued (hearing set for June 3 and 4, 2002; 9:00 a.m.; Tallahassee, FL).
|
Apr. 29, 2002 |
Joint Response to Initial Order (filed via facsimile).
|
Apr. 19, 2002 |
Initial Order issued.
|
Apr. 18, 2002 |
Final Agency Audit Report filed.
|
Apr. 18, 2002 |
Petitioners Amended Request for Hearing filed.
|
Apr. 18, 2002 |
Notice (of Agency referral) filed.
|