pris =D STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION gre HALIFAX MEDICAL CENTER, 2 ow? Y. “vt Petiti Ba G ectictioner, abe cs aoe mgt Wi | vs. DOAH CASE NO. 02-1964 32GS OO pet eo cent © a" Sh, fe 2a hese Cae wo AGENCY FOR HEALTH CARE ee on ADMINISTRATION, ™ c Respondent. ‘ / FINAL ORDER a” THE PARTIES resolved all disputed issues and executed settlement agreement” reference. which is incorporated by The parties are directed to comply with the foregoing, terms of the “settlement agreement” Based on the this proceeding is CLOSED Tw DONE and ORDERED on this the of 7 day of , 2002, in Tallahassee, Florida. bbe Medows, 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: David J. Davidson 303 N. Clyde Morris Blvd. Daytona Beach, FL 32120-2830 Kelly Bennett, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 Debbie Lynn Medicaid Program Integrity 2002 Old St.Augustine Rd. Bldg. D MS# 6 Tallahassee, FL Charlie Ginn Medicaid Program Integrity 2002 Old St.Augustine Rd. Bldg. D MS# 5 Tallahassee, FL Willie Bivens, Finance and Accounting CERTIFICATE OF SERVICE a SE 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 3 hiw day of Prins , 2002, Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 Halifax Medical Center can .: 02-1964 2. cai Pac torte No ° ; a STATE OF FLORIDA Inkh, Bb ™ rp) AGENCY FOR HEALTH CARE ADMINISTRATIG® ty oy 8 “Ugfig< “Sy HALIFAX MEDICAL CENTER, Oo “he Petitioner, v. AHCA CASE NO.: 02-1964 C.1. NO.: 01-0964-000 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / ee SETTLEMENT AGREEMENT This settlement agreement (“Agreement”) is entered into by and between the Agency for Health Care Administration (“AHCA”), and HALIFAX MEDICAL CENTER, (“Petitioner”), 1, This matter arises out of AHCA’s review of Petitioner's paid claims to Medicaid. On December 3, 2001, AHCA issued a Final Agency Action Letter (FAAL) that determined Petitioner had been overpaid by Medicaid in the amount of $86,511.97, 2. Petitioner filed a petition challenging AHCA’s determination and requesting a formal administrative hearing and requesting a formal reconsideration pursuant to Rule 596-4.150, F lorida Administrative Code (regarding Notices of Adverse Determination). 3. Prior to hearing in this matter, the parties met to exchange documents, review records, and discuss each of the claims at issue. As a result of the aforementioned discussions, the parties agree that the overpayment is $66,355.23 4. In order to resolve this matter without further administrative proceedings, Petitioner has agreed to repay $66,355.23, and to withdraw its request for administrative hearing with prejudice to refilling the petition. eee Halifax Medical Center DOAH Case No.: 02-1964 Page 2 of 4 5. AHCA agrees to accept $66,355.23, in the manner set forth herein in settlement of the Overpayment issues arising from the Medicaid review (C.I. 01 -0964-000). 6. Petitioner agrees to pay to AHCA in one Jump sum, the amount of sixty-six thousand three hundred fifty-five dollars and twenty-three cents ($66,355.23), to be paid within thirty (30) days of the issuance of a final order adopting this agreement. 7. Petitioner 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. 8. Petitioner 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: CI, 01-0964-000 9. Petitioner 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. 10. Payment shall be made payable to: AGENCY FOR HEALTHCARE ADMIN ISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 Payment shall clearly indicate that it is per a settlement agreement, shall reference the DOAH Case Number, and shall reference the C.1. Number. 1. Upon complete execution of this Agreement by Petitioner, this Agreement constitutes Petitioner’s’ dismissal of the petition and authorizes AHCA to file a Motion to Relinquish Jurisdiction with the Division of Administrative Hearings. 12. The parties will bear their own fees and costs associated with these proceedings. Halifax Medical Center DOAH Case No.: 02-1964 Page 3 of 4 13. 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. 14. 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. 15. This Agreement constitutes the entire agreement between Petitioner and AHCA, including anyone acting for, associated with or employed by them, concerning all matters relating to audit no. CI 01-0964-000 and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between Petitioner 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, 16, Petitioner 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, Petitioner further agrees that the Agency shall issue a Final Order adopting the terms of this settlement. However, if for any reason AHCA does not adopt this agreement, Petitioner reserves the right to re-open this matter with the Division of Administrative Hearings and shall have not waived any rights. 17. 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. 18. 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. Halifax Medical Center DOAH Case No.: 02-1964 Page 4 of 4 19. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. HALIFAX MEDICAL CENTER 303 North Clyde Morris Blvd, Daytona Beach, FL 32115 Cars L “Raymond Dated: “Yuoe. 2y , 2002 By: Coral. (print name above) Cwg (print title above) Dated: , lone 27 _, 2002 David J. Davidson Counsel forthe Petitioner PO Box 2830 Daytona Beach, FL 32120 AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 Dated: 7/ ZL , 2002 Inspector’General AEM Ak Dated: 7 (23 , 2002 William Roberts Acting General Counsel Dated: , 2002 elly Bennet — Assistant General Counsel

Docket for Case No: 02-001964MPI