PILED O3KOV-6 ps 2: 02 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION © vy : = oie 3 Petitioner, vs. CASE NO. 02-1908 mm PROVIDER NO. 054883900 STATE OF FLORIDA, AUDIT C.I. NO. 97-1606-000 AGENCY FOR HEALTH CARE Rendition No. AHCA-03-u44 -S-MDPB ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. 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 30_ day of Ochre , 2003, in Tallahassee, Florida. Medows, MD, Secretary 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) Peter Feaman, Esquire Adorno & Yoss, P.A. 700 S. Federal Highway, Suite 200 Boca Raton, Florida 33432 (U.S. Mail) Michael Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Phyllis Stiver, Medicaid Program Integrity John Hoover, 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 Oo day ot aneealts, 2003. Beavers DV Keeney 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 TIMOTHY R. TOWARD, D.O., Petitioner, vs. CASE NO. 02-1908MPI STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Timothy R. Toward, D.O. (“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 054883900 and was a provider during the audit period. 3. In its final agency audit report (final agency action) dated March 15, 2002, 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 $16,940.96. In response to the audit letter dated March 15, 2002, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 02-1908. . Timothy R. Toward, D.O. Settlement Agreement 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 $8,400.15. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: Q) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. (2) Within sixty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of eight thousand four hundred dollars and fifteen cents ($8,400.15) plus 10% interest will accrue after the thirtieth (30) day after the final order is rendered if the full amount has not been paid in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 02-1908). (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.J. 97-1606- 000. (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. _ Timothy R. Toward, D.O. 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. *_ Timothy R. Toward, D.O. Settlement Agreement 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. _ Timothy R. Toward, D.O. Settlement Agreement 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. TIMOTHY R. TOWARD, D.O. ft [Ns Dated: S@pr 2, 2003 BY? 1 (Hotey 1271 Owane Od (Print name) ITS: AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: Oct ther ee) , 2003 Judit Ey Hefr Acti spector General \ . ) Abd. hi Cx Dated: 04 LE , 2003 Valda Clark Christian General Counsel WV tow Dated: da lO 2003 L. William Porter IT Assistant General Counsel ves nae VRE Mpr ~TAHCA AGENCY FOR HEALTH CARE ADMINISTRATION RHONDA M. MEDOWS, MD, FAAFP, SECRETARY JEB BUSH, GOVERNOR Division of Administrative Hearings 2 YG D2 CERTIFIED MAIL - RETURN RECEIPT No. 7001 0360 0003 1560 6970 Provider No. 0548839-00 Timothy R. Toward, D.O. 2730 Broadway Riviera Beach, Florida 33404 In Reply Refer to FINAL AGENCY AUDIT REPORT C.1.97-1606-000 /WG9/PCS Dear Dr. Toward: In determining payment pursuant to codes, descriptions, policies, limitations and exclusions found in the Medicaid provider 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. ie ae _ _ ee Visit AHCA online at 2727 Mahan Drive « Mail Stop #6 www dhe. state fl.us Tallahassee, FL 32308 auuuuy KM. Loward, D.U. Page 2 REVIEW DETERMINATIONS The following review determinations were made by applying Medicaid policy to the medical record documentation provided by your office at the request of the Agency for Health Care Administration, Medicaid Program Integrity. Medicaid policy specifies how medical records must be maintained. A review of your medical records revealed that some services for which you billed and received payment Medicaid policy defines the varying levels of care and expertise required for the evaluation and management procedure codes for office visits. The documentation you Medicaid policy requires that payments be made only for those services listed in the provider handbook. You billed and received payment for services that, when reviewed by a physician consultant, indicated that the service was not Medicaid covered, Payments made to you for these services are considered overpayments. adjusted to the appropriate level of office visit. The difference between the amount you were paid and the correct fee is considered an overpayment. suuvuly &. LOWward, LU. Page 3 We therefore used the following statistical formula for cluster sampling: U(U-N Overpayment = E - t WOE —YB,)? Where: E = point estimate of overpayment = HDA 1S) B ]$24,750.37 u F = number of claims in the population = “2B 4,366 fal A; total overpayment in sample cluster $612.24 Bi= number of claims in sample cluster 108 U = number of clusters in the population, 92] N = number of clusters in the random sample, 29 N N Y = mean overpayment per claim = > 4/ > B,, $5.66888823 im} fal t=t value from the Distribution of t Table, 1.7011307 If you concur with the amount of the overpayment, please send your check in the amount shown in the first paragraph of this letter. The check must be payable to the Florida Agency for Heaith 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 edicaid Accounts Receivable Post Office 13749 Tallahassee, Florida 32317-3749 hereby informed that if a request for a hearing is made, the request or petition must be received Within twenty-one (21) days of receipt of this letter. Timothy R. Toward, D.O, Page 4 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 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. If you have any questions about this matter, contact Phyilis C, Stiver, Registered Nursing Consultant, Agency for Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 400 West Robinson Street, Suite 832, Hurston Towers South, Orlando, Florida 32801, telephone (407) 245-0862, ext. 185. Sincerely AHCA Administrator CGG:PCS:em Enclosures cc: Medicaid Accounts Receivable Medicaid Program Development Medicaid Program Integrity Administration Medicaid Program Integrity Work Group Five Area Medicaid Office

Docket for Case No: 02-001908MPI